The effect of steam sterilization on the physical properties and perceived cutting characteristics of extracted teeth.
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Biophysical Phenomena↗
Biomedical subjects
T G Nick
Publications and source records attributed to T G Nick.
Domestic violence in an inner-city ED.
STUDY OBJECTIVE: To determine the prevalence of domestic violence (DV) for male and female ED patients and to determine the demographics of DV. METHODS: The study design was a descriptive written survey of adults. We used the Index of Spouse Abuse (ISA), a previously validated survey tool. The study was set in an inner-city ED with approximately 75,000 patients annually, most of them indigent. Patients 18 years or older who were able to give consent were included. Patients were excluded if they had a language barrier, were a prisoner, or had never had a partner. All patients presenting during 31 randomly selected 4-hour shifts during July 1995 were considered for the study. DV was defined as either physical or nonphysical on the basis of ISA scoring. The prevalence was determined for present (in the preceding year) and past (more than 1 year ago) abuse. Four violence parameters were calculated for patients who had a partner at the time of presentation: present physical, present nonphysical, past physical, and past nonphysical. Only the "past" parameters were calculated for patients who had had a partner in the past but had no partner at the time of presentation. We used the chi2 test to determine individually significant predictors of the four parameters. Logistic-regression models were constructed to determine the significant predictors of DV. Associations among the present physical, present nonphysical, past physical, and past nonphysical abuse categories were determined with McNemar's test. RESULTS: We enrolled 516 patients, 233 men and 283 women. On the basis of ISA scoring, 14% of men and 22% of women had experienced past nonphysical violence (P=.02, men versus women), and 28% of men and 33% of women had experienced past physical violence (P=.35). Of the 157 men and 207 women with partners at the time of presentation, 11% of men and 15% of women reported present nonphysical violence (P=.20), and 20% men and 19% of women reported present physical violence (P=.71). Using logistic-regression models, we determined that women experienced significantly more past and present nonphysical violence but not physical violence than men. For all four parameters, the victim's suicidal ideation and alcohol use were independently associated with DV. The victim's family history was strongly associated with past abuse. Using McNemar's test, we found that physical and nonphysical abuse were correlated in the past and present. CONCLUSION: Using a validated scale, we found that the prevalences of physical DV for men and women are high and that they are not statistically different in this population. Using chi 2 testing, we found that women had experienced significantly more past nonphysical violence than men; using logistic regression we found that they experienced significantly more nonphysical violence (both past and present) than men. DV was frequently associated with suicidal ideation, alcohol use, and family history of violence.
Adolescent↗
Testing for treatment effect in the presence of regression toward the mean.
We are often faced with the statistical problem of evaluating the effect of a treatment in the extreme of a population. This requires taking measurements on truncated random variables and, hence, it becomes necessary to take proper account of the effect of regression toward the mean. The usual statistical procedures are inappropriate for testing treatment effect in the presence of regression toward the mean. Likelihood ratio and score tests based on truncated distributions should provide valid statistical inferences in these situations. We conducted simulation studies to investigate the properties of these methods and found that the likelihood ratio test performs well even when the sample size is moderate, whereas the score test does not seem to control the nominal significance level. We compared the likelihood ratio test to a regression-based t-test, assuming the mean of the baseline distribution to be known, and found the likelihood ratio test more powerful. In the case where the baseline mean is unknown, we also investigated Wald's test and compared it with the likelihood ratio test and score test with respect to validity and power using simulation. Wald's test and the score test do not control the nominal significance level unless the sample size is extremely large. Overall, the likelihood ratio test has the best performance among all the methods studied. The proposed likelihood ratio test is illustrated using an example of a cholesterol study.
Biometry↗
Moving toward a core curriculum in Schools of the Allied Health Professions: knowledge and skills considered important by department chairs in four disciplines.
An adaptation of the Delphi method was used in four parallel studies to survey chairs of baccalaureate programs in clinical laboratory sciences, health information management, occupational therapy, and physical therapy in schools of the allied health professions which held membership in the Association of Schools of the Allied Health Professions. The purpose was to assist the chairs in coming to consensus regarding requisite knowledge and skills of graduates beyond those required for professional accreditation and credentialing, and prerequisite or cognate courses that may be utilized to develop them. Three rounds of questionnaires were administered to each group. The final round was completed by 45 chairs in clinical laboratory sciences (83% of the population); 18 in health information management (86%); 18 in occupational therapy (56%); and 24 in physical therapy (67%). Statistical analysis of third round responses via one-sample, one-sided Z tests indicated consensus among the chairs in the four disciplines on 16 items of knowledge and skills as most important for graduates. Similar consensus was not evident, however, regarding courses to develop the knowledge and skills, with only two courses considered most important by all four groups of chairs.
Allied Health Personnel↗
Topical lidocaine adrenaline tetracaine (LAT gel) versus injectable buffered lidocaine for local anesthesia in laceration repair.
The objective of the study was to compare topical lidocaine adrenaline tetracaine (LAT gel) with injectable buffered lidocaine with epinephrine regarding pain of application or injection and anesthesia effectiveness. The study was a randomized prospective comparison trial in an urban emergency department. Physicians and patients ranked the pain of application, injection, and suturing according to a 10-cm visual analog scale. Sixty-six patients were entered, 33 in the LAT gel group and 33 in the injectable buffered lidocaine group. Injection was found to be significantly more painful than application of gel (P < 0.001). For anesthesia effectiveness, there was no difference according to patients (P = 0.48) or physicians (P = 0.83) for topical vs injectable forms. The number of sutures causing pain was not statistically different in the two groups (P = 0.28). In conclusion, LAT gel compared favorably with injectable buffered lidocaine for local anesthesia effectiveness and was significantly less painful to apply. It may be the preferred local anesthetic for this reason.
Administration, Topical↗
Adjustment of women with systemic lupus erythematosus.
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Adult↗
Ethanol ingestion and related hypoglycemia in a pediatric and adolescent emergency department population.
OBJECTIVE: To estimate the frequency of associated hypoglycemia in an ethanol-ingesting pediatric and adolescent population. METHODS: The study was a retrospective review of nondiabetic pediatric and adolescent patients with measurable ethanol levels (i.e., > or = 2 mmol/L) who had an ED serum glucose level determined. RESULTS: Over the four-and-a-half-year study period, there were 254,234 pediatric visits. One hundred eleven had ethanol levels determined (0.044% of patients) due to suspected ingestion. Of these 111, 88 had glucose levels determined. The mean age of the 88 patients was 14 years, with a mean glucose level of 5.6 mmol/L [101 mg/dL; interquartile range (IQR) 4.7-6.3 mmol/L] and a mean ethanol level of 30 mmol/L (IQR 15-43 mmol/L). Glucose levels were < 67 mg/dL (hypoglycemia) in three of the 88 (3.4%) ethanol-positive patients; all the hypoglycemic patients had significant behavioral changes. CONCLUSION: In this large retrospective series, the number of patients for whom the clinical suspicion of ethanol ingestion was confirmed was quite small. Hypoglycemia occurred in only 3.4% of these selected patients; all had altered behavior. Pediatric patients with presentations suggesting ethanol intoxication with altered behavior should be assessed for concurrent hypoglycemia.
Adolescent↗
Comparison trial of four injectable anesthetics for laceration repair.
OBJECTIVES: To compare four injectable anesthetics (buffered 1% lidocaine, buffered 1% lidocaine with epinephrine, plain 1% lidocaine with epinephrine, and 0.5% diphenhydramine with epinephrine) for pain of infiltration and effectiveness of anesthesia during suturing of minor lacerations. METHODS: A prospective, randomized, double-blind, comparison trial of the above agents was performed in an urban ED; adults with simple linear lacerations without vascular compromise were enrolled. Physicians and patients ranked the pain of injection and suturing according to a 10-cm visual analog scale (VAS). Fisher's exact and Kruskal-Wallis tests were used to compare demographic data, and Kruskal-Wallis and Newman-Keuls tests were used in analysis of VAS rankings. The power of the study was 0.8 to detect a 1.4-cm difference in VAS readings, and 0.9 to detect a 1.7-cm difference. RESULTS: Seven of 200 enrolled patients were excluded due to improper data collection and 13 were removed from final statistical analysis due to need for additional anesthetic (treatment failures), leaving 180 subjects for final analysis. Demographic data were similar for the four groups (p > 0.05). Diphenhydramine with epinephrine was significantly more painful to inject than was buffered lidocaine or buffered lidocaine with epinephrine, according to both the patients (p = 0.0003) and the physicians (p = 0.0037). The two buffered compounds were slightly less painful to inject than was lidocaine with epinephrine, but statistical comparisons did not reach significance. For anesthesia effectiveness, lidocaine with epinephrine and buffered lidocaine with epinephrine were statistically better than buffered lidocaine or diphenhydramine with epinephrine (p = 0.0001 for the patients and the physicians). CONCLUSIONS: Buffered lidocaine with epinephrine and lidocaine with epinephrine were more effective anesthetics during suturing, according to both the physicians and the patients. There was a tendency toward less pain with infiltration in buffered solutions, compared with plain lidocaine with epinephrine, but the comparisons did not reach statistical significance. Diphenhydramine with epinephrine was more painful to inject than were buffered lidocaine with epinephrine and lidocaine with epinephrine, and was less effective anesthetically than the other three solutions.
Adult↗
Research review: Perceptions of curriculum enhancement for baccalaureate programs in health information management.
Chairs of 21 baccalaureate programs in health information management in schools of the allied health professions with membership in the Association of Schools of the Allied Health Professions were surveyed in 1994 via a three-round Delphi process to identify desired competencies for graduates beyond those required for professional accreditation and credentialing and appropriate courses to develop them. Eighteen chairs (86 percent) completed the final questionnaire. Statistical analysis, including one-sample, upper-sided mean Z tests, indicated consensus among the 18 chairs that 27 items of knowledge and skills and 13 courses are most important.
Credentialing↗
Statistical validity for testing associations between genetic markers and quantitative traits in family data.
In genetic analysis it is often of interest to analyze associations between traits of unknown genetic etiology and genetic markers from pedigree data. Statistical methods that assume independence of pedigree members cannot be used because they disregard the statistical dependencies of members in a pedigree. For quantitative traits, a regression model proposed by George and Elston [Genet Epidemiol 4:193-201, 1987] uses an asymptotic likelihood ratio test and incorporates a correlation structure that allows for statistical dependence among the pedigree members. The statistical validity of this test is assessed for finite samples by measuring the discrepancy between the empirical and theoretical chi-square distributions. The variance of the mean of the dependent variable is determined to be related to this discrepancy and can be used to determine whether a pedigree structure is large enough for making valid statistical inferences on the basis of the asymptotic test. A multi-generational pedigree of 200 or so individuals should in many cases be sufficient for valid results when using the asymptotic likelihood ratio test for the association between markers and continuous traits.
Family↗
LAT (lidocaine-adrenaline-tetracaine) versus TAC (tetracaine-adrenaline-cocaine) for topical anesthesia in face and scalp lacerations.
The study objective was to compare the topical anesthetic LAT (4% lidocaine, 1:2,000 adrenaline, 1% tetracaine) to TAC (0.5% tetracaine, 1:2,000 adrenaline, 11.8% cocaine) for efficacy, adverse effects, and costs. The study design was a randomized, prospective, double blind clinical trial set in an inner-city emergency department with an emergency medicine residency program. Adults with linear lacerations of the face or scalp were eligible for inclusion in the study. Patients had lacerations anesthetized with topical TAC or LAT according to a random numbers table. A total of 95 patients were included in the study with 47 receiving TAC and 48 receiving LAT. Patients stated the number of sutures causing pain and patients and physicians rated the overall pain of suturing using a standard visual analog scale (VAS). The power of the study to determine a ranked sum difference of 15 was 0.8. Visual analog scale results and number and percentage of sutures causing pain were compared using Wilcoxon's Rank Sum Test. According to patients, the percentage of sutures causing pain was significantly fewer for LAT than TAC (P = .036, Interquartile Range 0.13 to 0.0 for LAT, 0.25 to 0 for TAC). Physicians found LAT statistically more effective than TAC (P = .0093, Interquartile Range 1 to 0 for LAT, 2 to 0 for TAC) but patients did not report a difference (P = .266, Interquartile Range 1 to 0 for both LAT and TAC). Our cost per application was $3.00 for LAT compared to $35.00 for TAC. Follow-up was accomplished in 91 of 95 patients (95%) with no reported complications for either medication.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Lidocaine via iontophoresis in laceration repair: a preliminary safety study.
Iontophoresis is a painless technique for topical anesthesia that uses an electric field to drive charged ions across an epithelial surface. The safety of this technique for laceration repair has never been demonstrated. The purpose of this study was to investigate the effect of iontophoretic fields on rapidly proliferating cells involved in laceration wound healing. The study was a prospective single-blinded animal study using a guinea pig model. Twelve guinea pigs each received four induced, uncontaminated lacerations. Each guinea pig was randomly assigned to 1 of 3 groups (4 guinea pigs in each group). One group received lidocaine via iontophoresis, one group received injected lidocaine, and one group received half iontophoresis and half injected lidocaine. After anesthetic treatment, wounds were then repaired in a standard fashion. The wounds were examined grossly on a daily basis and on day 10 the incised skin containing the laceration was examined by a pathologist blinded to the treatment group. A total of 48 wounds were assessed for wound healing, 24 of which received lidocaine via iontophoresis and 24 lidocaine via injection. The power of the study to determine a 40% difference between the two groups was 0.8. There was significantly more granuloma and granulation tissue formation in the iontophoresis group than in the injected lidocaine control group (P = .0004, Fisher's exact test).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Application of statistical inference techniques in health information management.
We have demonstrated that objective comparisons can be made using accepted statistical techniques. We have also shown that you can apply tests which don't meet the basic assumptions and still obtain valid results, in most cases. This robustness of statistics tests is particularly helpful with the type of data and analysis that health information management professionals typically deal with, where exactness of the results is not crucial. You can perform a quick analysis using simple statistical tools and obtain a P value that is fairly close to what it would be if you selected the tests more stringently. The examples of inferential statistics in this article demonstrate how to select tests based on characteristics of the data and how to interpret the results. The kinds of statistical analysis that can be performed in health information management are numerous. Below are some other ideas on how to use inferential statistics in HIM practice. 1. Set up an ordinal scale to evaluate coding accuracy to evaluate coders: Score 1 means the correct code was assigned for the principal diagnosis and only minor errors in coding among secondary diagnoses. Score 2 means the correct code was assigned for the principal diagnosis, but there are omissions or major errors among secondary diagnoses. Score 3 means a minor error in coding the principal diagnosis and only minor errors in secondary diagnoses. Score 4 means a minor error in coding the principal diagnosis and major errors or omissions in secondary diagnoses.(ABSTRACT TRUNCATED AT 250 WORDS)
Analysis of Variance↗
Desired competencies of doctorally prepared allied health faculty.
In 1994, a two-round adaptation of the Delphi method was used to assist deans of the Association of Schools of Allied Health Professions (ASAHP) institutional member schools offering programs at the baccalaureate level or higher to determine important competencies for future doctorally prepared allied health faculty. Thirty-six of the 68 deans invited to participate completed the second questionnaire. Statistical analysis on the frequency of responses and calculated mean responses, including one-sample Z-tests and adjusted p-values, identified 21 important competencies. This information should be considered by universities in the development or modification of graduate program curricula for the preparation of allied health faculty.
Allied Health Personnel↗
Lidocaine adrenaline tetracaine gel versus tetracaine adrenaline cocaine gel for topical anesthesia in linear scalp and facial lacerations in children aged 5 to 17 years.
STUDY OBJECTIVE: The purpose of the present study is to compare LAT gel (4% lidocaine, 1:2000 adrenaline, 0.5% tetracaine) to TAC gel (0.5% tetracaine, 1:2000 adrenaline, 11.8% cocaine) for efficacy, side effects, and costs in children aged 5 to 17 years with facial or scalp lacerations. DESIGN: Randomized, prospective, double-blinded clinical trial. SETTING: Inner-city Emergency Department with an Emergency Medicine residency program. PATIENTS OR OTHER PARTICIPANTS: Children aged 5 to 17 years with linear lacerations of the face or scalp. INTERVENTION: After informed consent was obtained patients had lacerations anesthetized with topical TAC or LAT gel according to a random numbers table. MEASUREMENTS AND MAIN RESULTS: A total of 95 patients were included in the statistical analysis with 47 receiving TAC and 48 receiving LAT. Physicians and patients/parents separately rated the overall pain of suturing using a modified multidimensional scale for pain assessment specifically for children. Patients/parents also stated the number of sutures causing pain. The power of the study to determine a ranked sum difference of 15 was 0.8. Multidimensional rating scale results and number and percentage of sutures causing pain were compared using Wilcoxon's rank sum test. According to patients no difference could be detected in percent of sutures causing pain in the LAT versus TAC group (P = .51). Using the multidimensional scale, physicians and patients/parents found LAT statistically the same as TAC in effectiveness (P = .80 for physicians and P = .71 for patients). Cost per application was $3.00 for LAT compared to $35.00 for TAC. Follow-up was accomplished in 85 of 95 participants in the study with no reported complications for either medication. CONCLUSION: LAT gel worked as well as TAC gel for topical anesthesia in facial and scalp lacerations. Considering the advantages of a noncontrolled substance and less expense, LAT gel appears to be better suited than TAC gel for topical anesthesia in laceration repair in children.
Adolescent↗
Ethylbenzene-mediated induction of cytochrome P450 isozymes in male and female rats.
Male and female Holtzman rats were exposed to ethylbenzene, and the effect on liver microsomal activities was studied. Hydrocarbon- and sex-dependent effects on P450-dependent metabolism of drugs and aromatic hydrocarbons were investigated. Hydrocarbon treatment produced two patterns of induction in cytochrome P450-dependent activities: (1) induction common to both sexes; and (2) induction exclusively in females. Benzphetamine N-demethylation, 7-ethoxycoumarin O-deethylation, p-nitroanisole O-demethylation and aromatic hydroxylation of toluene were induced in both sexes after rats were exposed to ethylbenzene. The rate of benzphetamine N-demethylation increased 4-fold in females and nearly doubled in males. The increase in O-deethylation of 7-ethoxycoumarin was 3-fold in females and doubled in males, while p-nitroanisole O-demethylation increased 4-fold in both sexes after exposure to ethylbenzene. Ethylbenzene had its greatest effect upon the formation of aromatic hydroxylated metabolites of toluene. Ethylbenzene exposure increased the rate of o-cresol formation by 4- and 9-fold in female and male rats, respectively. The formation rate of p-cresol was undetectable in either sex prior to hydrocarbon exposure; however, after the rats were given ethylbenzene, rates increased to 0.4 nmol/min/mg protein in females and to 0.9 nmol/min/mg protein in the males. Ethylbenzene exposure selectively induced aminopyrine demethylation, aniline hydroxylation, N,N-dimethylnitrosamine N-demethylation (DMNA) and aliphatic hydroxylation of toluene in females. Rates for aminopyrine, aniline, and DMNA were increased 50% over controls, while formation of benzyl alcohol from toluene was enhanced to 260% of control. Western immunoblotting indicated that ethylbenzene treatment induced cytochrome P450 2B1/2B2 to a greater extent in male rats and cytochrome P450 2E1 only in females. Ethylbenzene exposure did not affect significantly the level of cytochrome P450 1A1.
Animals↗
The incidence of ethanol-induced hypoglycemia.
The purpose of the study was to determine the incidence of ethanol-induced hypoglycemia. All nondiabetic patients who had blood alcohol levels above 0.10% and a random serum chemistry drawn (including glucose) were included. Over a 6-month study period, 378 patients were included in the study. Fifteen patients (4%) presented with hypoglycemia (glucose less than 67 mg%). Of these, four (1%) were profoundly hypoglycemic (glucose less than 50 mg%). Two hundred and fifty three patients (67%) patients were normoglycemic (glucose 67-106 mg%) and 110 patients (29%) were hyperglycemic (glucose greater than 106 mg%). Nonfasting glucose measurements from a control group of 96 nondiabetic, nonintoxicated patients were compared with those of the study group. Two patients (2%) presented with hypoglycemia and none (0%) presented with profound hypoglycemia. Forty-five patients (47%) presented with normoglycemia, and 49 (51%) with hyperglycemia. There were no statistically significant differences found in the hypoglycemia rate between the intoxicated patients and nonintoxicated control population (odds ratio of 0.75; P greater than .05). Four of 378 intoxicated patients (1%) had profound hypoglycemia (less than 50 mg/dL) compared with none (0%) of the 96 nonintoxicated patients. Intoxicated patients had a statistically significant lower rate of hyperglycemia in comparison with the nonintoxicated control group (29% versus 51%; P less than .0001). Age, sex, race, ethanol level, and serum electrolyte measurement had no predictive value for hypoglycemia in intoxicated patients. The anion gap was consistently elevated in hypoglycemic patients in comparison with normoglycemic patients (P less than .05). Hypoglycemia appears to occur as frequently in an ethanol-intoxicated population as in a population without elevated ethanol levels.(ABSTRACT TRUNCATED AT 250 WORDS)
Acid-Base Equilibrium↗
Sib-pair linkage tests for disease susceptibility loci: common tests vs. the asymptotically most powerful test.
Several statistical tests for linkage between a disease susceptibility locus and a marker locus for sib-pair data are examined analytically. Two common statistics, a test based on the mean number of marker alleles shared identical by descent by sib-pairs, and a test based on the proportion of sib-pairs sharing exactly two marker alleles, are shown to be special cases of a more general statistic. We use this more general statistic to derive the asymptotically most powerful statistic for a given genetic alternative hypothesis, and then compare this statistic with the "mean" statistic and the "proportion" statistic. Results indicate that the "mean" statistic generally compares well with the most powerful statistic. However, in some instances the "mean" statistic may lose power, relative to the most powerful. To guard against this, a new statistic (the maximum of the "mean" and "proportions" statistics) is considered and its asymptotic distribution is derived. Results indicate that this new statistic performs well.
Alleles↗