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PubMed1993

Predicting the course of disease.

The ability to predict the course of disease and the effect of interventions is critical to effective medical practice and health care management. In this analysis, we sought to test whether available clinical data and analytic methodologies can be used to accurately predict the time course of the probability of death after hospital admission and the probability of readmission following discharge for patients with acute myocardial infarction or pulmonary disease. We grouped patients by selected physiologic characteristics and made time-to-event predictions using multiple regression models. These predictions were compared with observed probabilities calculated using the actuarial or life-table method. Predictions made with the Bailey-Makeham model generally replicated observed experience. They accurately accounted for substantial differences in the patterns of death and readmission and accurately delineated the effects of therapies, after adjustment for patient risk. These results were validated by analyses of resampled populations that differed in case mix from the source population. We believe that using such models to project the course of disease and the effects of treatment on that course in defined classes of patients should facilitate the development of practice guidelines for patient care and the management of health care resources.

Disease↗
PubMed1993

The impact of comorbid and sociodemographic factors on access to renal transplantation.

OBJECTIVE: To assess the impact of sociodemographic factors and comorbid conditions on access to renal transplantation for adult US dialysis patients with end-stage renal disease (ESRD). DESIGN: Cohort analytic study. Data on comorbid conditions at onset of ESRD were abstracted from patients' medical records and matched to sociodemographic and ESRD data from the United States Renal Data System database. SETTING: United States Medicare dialysis population. PATIENTS: Random, national sample of ESRD patients starting dialysis in 1986 and 1987 (n = 4118). MAIN OUTCOME MEASURE: Time to first renal transplant (living or cadaver donor) since onset of ESRD regressed with two nested Cox proportional hazards models, first against sociodemographic factors alone, and then against sociodemographic factors and comorbid conditions. RESULTS: Cardiovascular diseases are most predictive of who received a transplant; patients with coronary heart disease, congestive heart failure, or left ventricular hypertrophy showed lower transplantation rates relative to patients without the disease (relative rate [RR] = 0.65 to 0.80, P < .05 each). Obese patients and patients with peripheral vascular disease also showed lower transplantation rates (RR = 0.65 to 0.75, P < .05 each). Previously reported sociodemographic effects of lower transplantation rates for older patients, women, nonwhite patients, and lower income patients were confirmed (P < .01). Sociodemographic effects remained essentially unchanged when adjusted for comorbid conditions. CONCLUSIONS: These findings indicate that sociodemographics have strong independent effects on access to transplantation that cannot be explained away as "surrogate" effects related to comorbid factors. Furthermore, the results suggest that lower mortality rates for transplant recipients relative to dialysis patients are due, in part, to a healthier case mix among patients receiving transplants.

Adult↗
PubMed1995

Transforms of the computerized patient record data model: from transactions to analytical processing.

The design of Computerized Patient Record databases needs to be different depending on whether the focus of the database is transaction processing or analytical processing. Transaction processing includes the operational use of databases for single patient update during clinical encounters. Analytical processing includes cross-patient querying for research or clinical management. These different design needs are defined. A case study is presented for the methodology that transforms transaction databases to analytical ones. The resulting analytical design is argued to be successfully evaluated according to specific criteria of useability and maintainability. This methodology is easily replicated in any relational database environment.

Computer Systems↗
PubMedDate not supplied

The yellowed archives of yellowcake.

Extensive historical documentation of exposures and releases at government-owned energy facilities is a unique and valuable resource for analyzing and communicating health risks. Facilities at all stages of the atomic fuel cycle were the subject of numerous industrial hygiene, occupational health, and environmental assessments during the Cold War period. Uranium mines and mills on the Colorado Plateau were investigated as early as the 1940s. One such facility was the mill in Monticello, Utah, which began operation as a vanadium extraction plant in 1943 and was later adapted to recover uranium from carnotite ores. The mill ceased operation in 1960. The site was added to the federal Superfund list in 1986. ATSDR held public availability sessions in 1993 as part of its public health assessment process, at which several former mill workers voiced health concerns. An extensive literature search yielded several industrial hygiene evaluations of the Monticello mill and health studies that included Monticello workers, only two of which had been published in the peer-reviewed literature. In combination with the broader scientific literature, these historical reports provide a partial basis for responding to mill workers' contemporary health concerns. The strengths and limitations of the available exposure data for analytical epidemiologic studies and dose reconstruction are discussed. As an interim measure, the available historical documentation may be especially helpful in communicating about health risks with workers and communities in ways that acknowledge the historical context of their experience.

Chronic Disease↗
PubMedDate not supplied

Particulate pollution and health: a review of the Utah valley experience.

Utah Valley has provided an interesting and unique opportunity to evaluate the health effects of respirable particulate pollution (PM10) for several reasons. (1) It has moderately high average PM10 levels, and during low-level temperature inversion episodes, local emissions may become trapped in a stagnant air mass near the valley floor, resulting in highly elevated PM10 concentrations. (2) The valley experienced the intermittent operation of the local integrated steel mill, the largest single particulate pollution source. (3) Valley residents have very low smoking rates. (4) Levels of sulfur dioxide, ozone, and aerosol strong acidity are relatively low. Several studies specific to Utah Valley have evaluated associations between various indicators of health and PM10 pollution. Each of these individual studies has limitations imposed by data and analytic constraints. Taken together, however, they suggest a coherence or cascade of associations across various health end points for a specific location and population. Apparent health effects of elevated PM10 pollution observed in Utah Valley include: 1) decreased lung function; 2) increased incidence of respiratory symptoms; 3) increased school absenteeism; 4) increased respiratory hospital admissions; 5) increased mortality, especially respiratory and cardiovascular mortality; and 6) possibly increased lung cancer. This paper reviews these Utah Valley studies and evaluates the possibility that the overall health associations observed are due primarily to methodological bias or confounding by inadequate controls for risk factors such as smoking, weather, season, infectious agents, and socioeconomic distress.

Air Pollutants↗
PubMed1996

Switchboard simulation to improve productivity and customer service.

An application of classical industrial engineering/operations research techniques (i.e., multichannel queueing analysis) and detailed workload distribution data. An analytic simulation model developed on a personal computer (PC) is used with interactive analysis to develop switchboard coverage requirements and optimal staffing schedules by time of day and day of week. This represents a tangible example of how classical techniques can be used with newer approaches and a close working relationship between the analyst and line management, to solve a practical problem of optimizing both productivity and customer service quality.

Computer Simulation↗
PubMed1996

Oedipal and preoedipal transference transformations. Comments on the analysis of a latency-age boy.

The critical importance of both oedipal and preoedipal unconscious conflicts in child and adult analysis as these conflicts unfold through the transference is documented using analytic process data. Evidence is provided that demonstrates the equal relevance of these psychic conflicts and their continuous interactions. The concept of transference transformations is proposed to explain these and later psychic conflicts that are resolved through the mutative interpretations unique to psychoanalysis. Extensive clinical data from the analysis of a latency-age boy are presented in support of this thesis. Thus, transference neurosis that arises from the infantile neurosis, the structural residue of the Oedipus complex, would be subsumed within the group of transference transformations. This concept eliminates the obligation to emphasize one developmental phase over another.

Adult↗
PubMed1997

Population-based, genetically informative sample for studies of physical frailty and aging: black elderly twin study.

In this article 1 describe efforts to build a genetically informative, population-based sample of black twins to study physical frailty and aging in the United States. This project involves the use of governmental registries combined with sampling techniques developed to overcome limitations in the registry data. Two analytical approaches to measures of disability are included to illustrate the types of questions that can be addressed with this sample. These results suggest that physical disability in late life has both genetic and environmental determinants. Only with a genetically informative sample can evidence be collected indicating that frailty may be driven by fixed processes (i.e., disability resulting from activation of senescence genes), fluid processes (i.e., disability resulting from changes in the features of the environment), or a combination of both.

Activities of Daily Living↗
PubMed1995

Uncertainty and decisions in medical informatics.

This paper presents a tutorial introduction to the handling of uncertainty and decision-making in medical reasoning systems. It focuses on the central role of uncertainty in all of medicine and identifies the major themes that arise in research papers. It then reviews simple Bayesian formulations of the problem and pursues the generalization to the Bayesian network methods that are popular today. Decision making is presented from the decision analysis viewpoint, with brief mention of recently-developed methods. The paper concludes with review of more abstract characterization of uncertainty, and anticipates the growing importance of analytic and "data mining" techniques as growing amounts of clinical data become widely available.

Bayes Theorem↗
PubMed1998

Epidemiology of digestive tract cancers in India. II. Stomach, and gastrointestinal lymphomas.

The incidence of stomach cancer and GI lymphomas is low in most parts of India. There is paucity of analytical epidemiologic data on these from India. While the time trends for the incidence of gastric cancer are encouraging, most cancers are diagnosed in an advanced stage when long-term cure is only a remote possibility. Multi-center epidemiologic studies should be undertaken to solve some of the enigmas and observations peculiar to India.

Adult↗
PubMed1998

[Evaluation of the cost of treatment for terminal chronic renal insufficiency. Thoughts on the value of this type of study and the role of the nephrologist].

To assess the cost of end stage renal failure treatment was the target of studies we achieved during the last ten years. We showed how much the global cost was favourably influenced by the number of available therapeutic methods. In a recent study, reported here, we followed a new methodology more often used today in our public hospitals. The comparison of analytical accountancy data with computerized medical informations as given by identification of Diagnosis Related Groups probably allows better assessment of "real cost". But is this approach really useful for nephrologists? These frequently asked questions cannot be performed without the participation of physicians. The question remains whether or not these studies will contribute to improve the quality of care and to allow some saving. We also hope sharing with readers of "Nephrologie" these kinds of considerations as well as our opinions and doubts.

Health Care Costs↗
PubMed1998

Cancer incidence and mortality across Canada.

OBJECTIVES: This article analyses provincial and territorial patterns in incidence and mortality rates for selected cancer sites. DATA SOURCES: Cancer incidence data were obtained from the National Cancer incidence Reporting System and from the Canadian Cancer Registry. Mortality data are from the Canadian Vital Statistics Data Base. ANALYTICAL TECHNIQUES: Age-standardized incidence and mortality rates were calculated for Canada and each province/territory for men and women for major cancer sites for the 1991-1993 period. MAIN RESULTS: Geographic variations in cancer incidence and mortality rates are strongly influenced by trends in the four leading cancers: lung, colorectal, prostate and breast. Cancer rates tended to be significantly high in Quebec and Nova Scotia and significantly low in the three westernmost provinces. These patterns generally reflect provincial/territorial variations in smoking prevalence, dietary habits, and the extent of cancer control programs, such as screening.

Age Distribution↗
PubMed1998

Childhood asthma.

OBJECTIVES: This article describes trends in the prevalence of asthma among children aged 0 to 14 from 1978/79 to 1994/95, and in hospital separations for asthma from 1974/75 to 1994/95. It also examines factors associated with childhood asthma. DATA SOURCES: Information on asthma among children aged 0 to 11 is from the 1994/95 National Longitudinal Survey of Children and Youth (NLSCY), and among children aged 12 to 14, from the 1994/95 National Population Health Survey (NPHS). Hospital separation data are from the Hospital Morbidity File. Mortality data are from the Canadian Vital Statistics Data Base. ANALYTICAL TECHNIQUES: Prevalence estimates of asthma were calculated based on a sample of 22,831 children aged 0 to 11 from the NLSCY and 637 children aged 12 to 14 from the NPHS. Logistic regression was used to estimate the odds of asthma among children aged 0 to 11 by selected characteristics. MAIN RESULTS: The prevalence of childhood asthma and hospital separations rates for asthma have increased sharply. A history of bronchitis and allergies, parental asthma, and residence in the Atlantic provinces and Quebec are associated with higher rates of asthma in children.

Adolescent↗
PubMed2004

Stereochemistry of new nitrogen containing heterocyclic aldehyde. Part XI. Novel ligational behaviour of quinoline as chelate ligand toward transition metal ions.

Novel complexes of Mn(II), Fe(II), Co(II), Ni(II), Cu(II), Zn(II) and UO2(II) with a new Schiff base derived from 8-hydroxy-7-quinolinecarboxaldehyde and 2-aminoethanethiol (LH2) (system name: 2-(8-hydroxy-7-carboxalimino)ethanethiol.) have been prepared and characterized on the basis of analytical, thermal, magnetic moment, infrared, electronic, NMR and EPR spectral data. From the analytical, NMR and thermal data and stoichiometry of the complexes indicate that LH2 act as a dibasic tridentate ligand with ONS donors towards all the metal ions. The magnetic moment, electronic and EPR spectral data commensurate that the Mn(II), Fe(II), Ni(II) and UO2(II) complexes are dimeric with octahedral configuration while the Cu(II) and Zn(II) complexes are monomeric with square-planar and tetrahedral geometries, respectively. Various ligand field parameters Dq, B and beta for complex 5 was calculated. The complexes 3+4 have lower symmetries and the amount of distortion in terms of DT/DQ applying NSH "Hamiltonian Theory" has been evaluated which indicate that the complexes are moderately distorted.

Aldehydes↗
PubMed2004

Plasma or serum samples: measurements of cardiac troponin T and of other analytes compared.

Conflicting data in the literature concern possible differences in the immunochemical measurement of cardiac troponins, either in plasma or in serum. In order to address this specific point, 96 serum and heparin-plasma pairs were obtained for cardiac marker measurement [cardiac troponin T (cTnT); myoglobin (Myo) and creatine kinase-MB isoenzyme (CK-MB)]; 29 additional "common" analytes were measured in 77 such samples. The cardiac markers were measured by electrochemiluminescence (Elecsys 2010, Roche); the other analytes by established automated methods (Modular, Roche). Mean plasma/serum ratios for cTnT (0.95), creatine kinase-MB (1.01) and myoglobin (0.99) were comparable with those of the 29 common analytes (interval of means 0.83-1.05). The distribution of the plasma-serum differences also showed similarities between cardiac markers and other analytes. A few outlier plasma-serum differences (3-5%) were measured for both categories of analytes. Addition of heparin to serum (51 samples) caused decreased cTnT (mean ratio 0.92). In 3 of 51 such samples the cTnT decrease was more marked, but in a second sample from the same subjects (1 week later) such a prominent, heparin-induced loss of cTnT no longer appeared. In conclusion, plasma-serum differences in immuno-reactive cTnT compare with those observed for other analytes. In occasional heparin-plasma samples immunochemical measurement of cTnT may give exceptionally low values. However, in our sample group of 96 patients (cTnT lower or higher than the cut-off in, respectively, 24 and 72 patients), no misclassification occurred if plasma instead of serum cTnT values were considered.

Biomarkers↗
PubMed2006

Unquenched complex dirac spectra at nonzero chemical potential: two-color QCD lattice data versus matrix model.

We compare analytic predictions of non-Hermitian chiral random matrix theory with the complex Dirac operator eigenvalue spectrum of two-color lattice gauge theory with dynamical fermions at nonzero chemical potential. The Dirac eigenvalues come in complex conjugate pairs, making the action of this theory real and positive for our choice of two staggered flavors. This enables us to use standard Monte Carlo simulations in testing the influence of the chemical potential and quark mass on complex eigenvalues close to the origin. We find excellent agreement between the analytic predictions and our data for two different volumes over a range of chemical potentials below the chiral phase transition. In particular, we detect the effect of unquenching when going to very small quark masses.

Journal Article↗
PubMed1994

Process capability and stability of analytical systems assessed from proficiency testing data.

Participation in a proficiency testing (PT) program is a valuable adjunct to laboratory activities dedicated to the maintenance of reliable analytical methods. The PT program may facilitate continuous quality improvement if laboratory performance is presented in the context of expectations espoused by healthcare professionals for optimal patient care. Statistical process control (SPC) and capability analysis are tools used by industry in a Total Quality Management environment to characterize and monitor the performance of its processes relative to performance specifications. I conceptualized the use of an analytical system by many laboratories as a process that periodically produces results from the analysis of PT specimens. I treated a set of five PT results (theophylline) reported by a laboratory as a process sample and subjected the samples collected from many laboratories to SPC and capability analysis. The control charts--mean-(X-bar) and s-charts--produced by the analysis readily identify significant analytical errors in the context of peer performance and performance specifications provided by the regulatory program and analytical goal setting. The capability index (desirable Cp > 1.0) determined from clinical specification limits for the three analytical systems evaluated suggests an opportunity for improvement of laboratory performance.

Chemistry, Clinical↗
PubMed1995

Streptococcal group C bacteremia. Survey in Israel and analytic review.

BACKGROUND: Data concerning group C streptococcal bacteremia come mainly from case reports; thus, population-based studies from different geographic areas are needed to validate these findings. METHODS: Eight years of data on group C streptococcal infection in Israel and cases of bacteremia in five hospitals were reviewed. We compared data from our survey as well as from other population-based studies with multiple cases published as case reports. RESULTS: The organisms were isolated in 78 cases (excluding pharyngitis); 16 had bacteremia. Ten cases of bacteremia were reviewed in five hospitals; none of the patients reported exposure to animals, and nine had severe underlying diseases. The clinical syndromes included four cases of primary bacteremia, four cutaneous infections, and one case each of meningitis and pneumonia. There were two deaths, one patient underwent amputation of a toe, one had a stroke, and one had a relapse. We compared 80 cases published as case reports with 59 cases reported in five population-based studies from different countries. We found higher rates of underlying diseases, alcohol abuse, liver diseases, and cutaneous infections, and lower rates of exposure to animals or raw products, endovascular infections, and central nervous system infections in population-based studies. Morbidity and mortality were 20% to 30% each in both types of studies. CONCLUSIONS: Group C streptococcal bacteremia affects patients with underlying diseases; exposure to animals is variable and less frequent than previously reported. Morbidity and mortality are high and probably reflect the patients' underlying state as well as the severity of the infection.

Adolescent↗

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