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PubMed1997

Nursing care of the Paratrend 7 sensor.

The Paratrend 7 sensor is a continuous intravascular blood gas sensor that consists of a miniaturized Clark-type PO2 electrode, fibreoptic pH and PCO2 optodes and a thermocouple, the monitor continuously displays the measured pH, PaO2 PaCO2 and temperature of the blood, and the calculated oxygen saturation, BE and SBC. After 7 years of caring for over 200 patients following insertion of the sensor, we describe our nursing experience with particular emphasis on the adequate fixation of the cannula, sensor system and connectors. The maintenance of the sensor through adequate flushing of the arterial line and care of the insertion site is described. Also outlined are the potential advantages to nursing practice of this new monitoring system, with particular reference to early warning of deterioration in respiratory function, closer control of mechanical ventilation and reduction in blood gas sampling and the errors inherent therein.

Blood Gas Analysis↗
PubMed2001

A limited sampling strategy for cyclosporine area under the curve monitoring in lung transplant recipients.

We developed a limited sampling strategy (LSS) for predicting cyclosporine (Neoral) area under the curve from concentration-time data obtained specifically from lung transplant recipients. The optimal and most clinically convenient LSS for lung transplant recipients, based on patient wait time, number of blood samples required, percent prediction error, and assessment of predictive performance is one that requires 2 blood samples collected at 1 and 3 hours post-dose: AUC = 1.75 x C(1) + 4.91 x C(3) + 185.62.

Adult↗
PubMed1997

Sterile versus clean technique in postoperative wound care of patients with open surgical wounds: a pilot study.

PURPOSE: This study was completed to determine whether there were differences between sterile versus clean dressing change technique for open surgical wounds in the postoperative period with respect to (1) rate of wound healing and (2) cost of supplies. METHODS: A two-group design was used for this pilot study. Of a sample of 30 patients undergoing elective gastrointestinal operations with wounds healing by secondary intention, 15 were men and 15 were women. Mean age was 40.6 years (SD 13.0 years). Patients were randomly assigned to receive clean or sterile dressings, and the intervention was begun on the first postoperative day and repeated three times a day until discharge from the hospital. Analysis of rate of healing was performed with the Mann-Whitney U test: cost analysis was completed with a t test. FINDINGS: Subjects were studied for 3 to 9 days. Groups were homogeneous of the start of treatment with respect to age, length of operation, wound volume, nutritional status, and perfusion. There was no difference in rate of wound healing between the clean and sterile groups. Mean cost was significantly less for the clean group than for the sterile group. CONCLUSION: These pilot study data show no difference in rate of wound healing with clean versus sterile technique, and clean technique is less expensive. These findings need to be confirmed with a larger sample; type II error cannot be ruled out.

Adult↗
PubMed1999

Visual acuity screening versus noncycloplegic autorefraction screening for astigmatism in Native American preschool children.

INTRODUCTION: Visual acuity screening (VAS) is less reliable in preschoolers than in school-aged children as a means of detecting significant refractive error. We wished to compare the effectiveness of VAS with the effectiveness of an objective method, noncycloplegic autorefraction screening (NCARS), in detecting the presence of significant astigmatism warranting spectacle correction. METHODS: We examined 245 Native American Head Start registrants aged 3 to 5 years. We attempted to obtain uncorrected visual acuity using Lea Symbols logMAR Chart (Precision Vision Inc, Villa Park, Ill), noncycloplegic autorefraction using the Nikon Retinomax K-plus (Nikon Corp, Melville, NY), and cycloplegic refraction (CR) on each eye. The VAS failure criterion was either a 2-line acuity difference between eyes or acuity worse than 20/40 in either eye. The NCARS and CR failure criterion was the spectacle correction threshold exceeding the 50th percentile on the basis of a survey of AAPOS members. RESULTS: We completed VAS in 96% of children and NCARS and CR in 100% of children. There was high prevalence (31%) of significant astigmatic refractive error in this sample. Ten subjects who did not permit bilateral visual acuity measurements were scored as having a positive test result. The sensitivity and specificity of VAS were 90% and 44%, respectively. NCARS had sensitivity and specificity of 91% and 86%, respectively. NCARS becomes cost-effective after 1044 children are screened, assuming that the cost of the autorefractor is 300 times the cost of the referral examination. CONCLUSION: VAS offers high sensitivity but suffers from poor specificity. NCARS greatly reduces the number of unnecessary referrals. In this population, NCARS becomes cost-effective after approximately 1000 children are screened.

Arizona↗
PubMed2001

Effects of screening errors and differential mortality on the estimation of the incidence of dementia in the Canadian Study of Health and Aging.

The Canadian Study of Health and Aging produced an estimate of the incidence of dementia among elderly Canadians by following up, after 5 years, the undemented found in an initial prevalence survey. Initial and follow-up estimates could be biased by false-negative error in the screening tool used for subjects living in the community, and by erroneous classification of subjects who died in the interim. Here, we use a deterministic model to quantify those possible biases. We conclude that, using the estimates of the errors from control samples, the incidence among community subjects would be overestimated by 15%, and the incidence among the institutional subjects would be underestimated by 37%. The overall incidence would be underestimated by 14%. Most of the bias can be attributed to inaccuracies in the classification of deaths.

Aged↗
PubMed2001

Identification of nucleotides with identical fluorescent labels based on fluorescence polarization in surfactant solutions.

A solution-phase steady-state polarization-based method for discriminating among the four DNA nucleotides labeled identically with tetramethylrhodamine is described and demonstrated. Labeled nucleotides were dissolved in buffered surfactant solutions. In room temperature 4.5 mM Triton X-100 solutions at neutral pH, the measured steady-state polarizations of tetramethylrhodamine-labeled dATP, dCTP, dGTP and dUTP were 0.261 +/- 0.003, 0.112 +/- 0.003, 0.288 +/- 0.003, and 0.147 +/- 0.003, respectively. A blind test of 40 samples showed no errors in classification based on polarization. The reproducibility obtained during this study demonstrates that the four dye-labeled nucleotides can be discriminated with more than 99.8% confidence.

Deoxyadenine Nucleotides↗
PubMedDate not supplied

Colorimetric diffusion-reflection imaging high-throughput analysis of organic or inorganic compounds.

A colorimetric diffusion-reflection imaging (CDRI) high-throughput analytical technology was developed for library analysis. In the investigation, quartz sands were employed as light diffusion-reflection media. Inorganic and organic compounds with characteristic absorption bands in visible light could be quantified by this method. In the current investigation, compounds such as CrCl3, KMnO4, methylene blue, and acrolein were employed as substrates, and the UV spectrometer and traditional GC (with thermal conductivity detector) were employed to check the reliability of our CDRI technology. The current technology is capable of analyzing more then 100 samples simultaneously. Relative errors below 10% were achieved.

Acrolein↗
PubMed2003

Using DNA-binding proteins as an analytical tool.

We propose that DNA-binding proteins can be used as highly efficient and versatile tools in analyses of DNA, RNA, and proteins. This work reports assays applying specific affinity probes: hybridization probes for analyses of DNA and RNA, and aptamer probes for analyses of proteins. Both types of probes are single-stranded DNA. In affinity analyses, in general, the probe (P) binds to a target molecule (T), and the amounts of the probe-target complex (P.T) and unbound P are determined. Distinguishing between P and P.T can be achieved by electrophoretic separation. If the electrophoretic mobilities of P and P.T are close in gel-free media, which is always the case for hybridization analyses, separation typically requires the use of a sieving matrix. Here we utilized a single-stranded DNA binding protein (SSB) to facilitate highly efficient gel-free separation of P and P.T in capillary electrophoresis (CE) for three types of targets: DNA, RNA, and proteins. When present in the CE run buffer, SSB binds differently to P and P.T. Due to this selective binding, SSB induces difference in electrophoretic mobilities of P and P.T in an SSB concentration-dependent fashion. The difference in the electrophoretic mobilities allows for affinity analyses of DNA, RNA, and proteins in gel-free CE. The large number of well-characterized DNA- and RNA-binding proteins and the diversity of their properties will allow researchers to design a comprehensive tool set for quantitative analyses of DNA, RNA, and proteins. Such analyses will facilitate identification of genomic DNA in ultra-small samples without error-prone and time-consuming PCR. They can also be used for monitoring gene expression at both mRNA and protein levels.

DNA Probes↗
PubMed1990

Subliminally activated symbiotic fantasies: facts and artifacts.

A quantitative review of subliminal symbiotic activation research is presented. Ss viewed Mommy and I are one and other psychoanalytically relevant or neutral stimuli at subliminal exposure levels, and comparative effects on adaptive behavior were observed. The review procedure was one in which the results of a meta-analysis were corrected for statistical artifacts. Small but significant effects were revealed. All observed variance between studies is attributable to random sampling and measurement error. Future research designed to replicate basic experimental effects is deemed superfluous. Some implications for psychoanalytic theory, cognitive science, and subliminal perception research are discussed.

Fantasy↗
PubMed1994

Oral communication skills of children who are hard of hearing.

Forty children with mild to severe hearing losses were administered a battery of speech and language tasks. The children's speech was characterized by misarticulation of affricates and fricatives, mild-moderate hoarseness, mild resonance problems, and good intelligibility. Their language samples included syntactic errors, primarily involving the use of bound morphemes and complex sentence structures. The children's pragmatic errors consisted primarily of providing inadequate or ambiguous information to the listener. These results indicate a consistent pattern of oral communication behavior that reflects the reduction of acoustic input that they experience.

Articulation Disorders↗
PubMed2002

A population-based study of cigarette smoking among illicit drug users in the United States.

AIMS: People who use illicit drugs are thought to have high rates of cigarette smoking; however, few population-based studies have been reported. We describe smoking patterns among illicit drug users, assess whether cigarette smoking is more prevalent among illicit drug users than it is among non-users and explore how smoking relates to level and type of drug use. DESIGN, SETTING, PARTICIPANTS: We used adult responses to the 1997 National Household Survey on Drug Abuse (n = 16 661). Multivariate analyses used SUDAAN to adjust standard errors for the sampling design and controlled for age, race, sex, education, depression, treatment history and alcohol. MEASUREMENTS: Smoking rates, cessation rates and smoking levels. FINDINGS: Seventy-one per cent of recent illicit drug users smoked cigarettes at least once in the past month. Their adjusted odds of being a smoker were much greater than for the general population (OR = 3.07, P < 0.0001). Their quit rate, although substantial, was half that of non-users (23% versus 56%, P=0.0001). Odds of being a smoker were higher for poly- versus monodrug users (OR = 2.35, P=0.0020) and rose with increased drug use (OR = 1.36, P=0.0374). Illicit drug users who perceived smoking to be risky were four times less likely to smoke (OR = 0.23, P=0.0008). CONCLUSIONS: Although most recent illicit drug users smoke, some are able to quit. Better understanding of concurrent cigarette and illicit drug use may provide impetus for policy change and shed light on underlying mechanisms of addiction. Clinicians, policy makers and user advocates should address tobacco use in drug treatment and in harm reduction interventions.

Adolescent↗
PubMed2001

Quantitative serial sectioning analysis.

A method for serial sectioning is presented that allows one to take about 20 sections per hour with spacings in the range 1-20 microm between sections. The alignment of the cross-sections is done with a linear variable differential transformer; it is thus independent of the microstructure of the sample and does not rely upon markers implanted in the sample. The alignment errors as well as tilts and rotation errors between sections associated with the new method are found to be negligible. Once all the sections are captured in a computer a three-dimensional image can be constructed. This image can be viewed interactively and rotated, thus allowing the direct observation of three-dimensional shapes. It can further be used to determine a vast array of microstructural parameters including those that cannot be determined from planar sections. The technique is illustrated through the reconstruction of the microstructure of a cast standard aluminium alloy specimen.

Alloys↗
PubMed1998

Task analysis for the investigation of human error in safety-critical software design: a convergent methods approach.

An investigation was conducted into sources of error within a safety-critical software design task. A number of convergent methods of task- and error-analysis were systematically applied: hierarchical task analysis (HTA), error log audit, error observation, work sample and laboratory experiment. HTA, which provided the framework for the deployment of subsequent methods, revealed possible weaknesses in the areas of task automation and job organization. Application of other methods within this more circumscribed context focused on the impact of task and job design issues. The use of a convergent methods approach draws attention to the benefits and shortcomings of individual analysis methods, and illustrates the advantages of combining techniques to analyse complex problems. The features that these techniques should possess are highlighted.

Ergonomics↗
PubMed2000

Concentration and composition of atmospheric aerosols from the 1995 SEAVS experiment and a review of the closure between chemical and gravimetric measurements.

We summarize the results from the various measurements and the inter-sampler comparisons from Southeastern Aerosol and Visibility Study (SEAVS), a study with one of its objectives to test for closure among chemical, gravimetric and optical measurements of atmospheric aerosol particles. Sulfate and organics are the dominant components of the SEAVS fine particles (nominally, particles with aerodynamic diameter < or = 2.5 microns) but between 28 and 42% (range over various samplers) of the gravimetrically measured total fine particle concentration is unidentified by the chemical measurements. Estimates of water associated with inorganic components and measurement imprecision do not totally explain the observed difference between gravimetric and chemical measurements. We examine the theoretical and empirical basis for assumptions commonly made in the published literature to extrapolate total fine particle concentration on the basis of chemical measurements of ions, carbon and elements. We then explore the more general question of closure using the SEAVS data as well as data from other, similar studies reported in the literature. In so combining the SEAVS measurements with other similar studies, we find a strong association between organic carbon and the unidentified component, that is, the fraction of the total fine particle concentration not identified by chemical measurements. We offer several tenable hypotheses for the relationship between the organic and unidentified components that deserve to be tested in future work. Specifically, we hypothesize that (1) errors in the sampling and analysis of organic carbon; (2) estimates of organic mass from measurements of organic carbon; and/or (3) water absorption by organics may all contribute to the observed relationship.

Aerosols↗
PubMed1983

Optimal design of the chronic animal bioassay.

Optimal experimental designs for carcinogenicity bioassays conducted for the assessment of risks associated with exposure to environmental chemicals are derived. For our purposes, an optimal experimental design is a design that minimizes the mean-squared error of the maximum likelihood estimate of the virtually safe dose from the Armitage-Doll multistage model and maintains a high power for the detection of increased carcinogenic response. Three- and four-dose designs (including control as one of the doses) are discussed for a variety of dose response patterns. Monte Carlo simulation techniques are used to estimate the power and mean-squared error for small samples sizes. Two forms of the multistage model are used to estimate the virtually safe dose: the linear model and the linear-quadratic model. The optimal designs for fitting the linear model used a control group and a group administered the maximum tolerated dose, with about 50% of the animals at each dose. The three- and four-dose optimal designs when fitting the linear-quadratic model were found to be equivalent. However, after considering several biological issues, including overt toxicity, the optimal four-dose designs would use between 150 and 300 animals, with 50 to 60 animals in the control group, and 40 to 60 animals in the group administered the maximum tolerated dose. One-third of the remaining animals would be administered a dose between 10 and 30% of the maximum tolerated dose, and two-thirds of the remaining animals would be administered 50% of the maximum tolerated dose.

Animals↗
PubMed2005

St. George's Respiratory Questionnaire: MCID.

The SGRQ is a disease-specific measure of health status for use in COPD. A number of methods have been used for estimating its minimum clinically important difference (MCID). These include both expert and patient preference-based estimates. Anchor-based methods have also been used. The calculated MCID from those studies was consistently around 4 units, regardless of assessment method. By contrast, the MCID calculated using distribution-based methods varied across studies and permitted no consistent estimate. All measurements of clinical significance contain sample and measurement error. They also require value judgements, if not about the calculation of the MCID itself then about the anchors used to estimate it. Under these circumstances, greater weight should be placed upon the overall body of evidence for an MCID, rather than one single method. For that reason, estimates of MCID should be used as indicative values. Methods of analysing clinical trial results should reflect this, and use appropriate statistical tests for comparison with the MCID. Treatments for COPD that produced an improvement in SGRQ of the order of 4 units in clinical trials have subsequently found wide acceptance once in clinical practice, so it seems reasonable to expect any new treatment proposed for COPD to produce an advantage over placebo that is not significantly inferior to a 4-unit difference.

Data Interpretation, Statistical↗
PubMed2000

Proton spectroscopic imaging of polyacrylamide gel dosimeters for absolute radiation dosimetry.

Proton spectroscopy has been evaluated as a method for quantifying radiation induced changes in polyacrylamide gel dosimeters. A calibration was first performed using BANG-type gel samples receiving uniform doses of 6 MV photons from 0 to 9 Gy in 1 Gy intervals. The peak integral of the acrylic protons belonging to acrylamide and methylenebisacrylamide normalized to the water signal was plotted against absorbed dose. Response was approximately linear within the range 0-7 Gy. A large gel phantom irradiated with three, coplanar 3 x 3 cm square fields to 5.74 Gy at isocentre was then imaged with an echo filter technique to map the distribution of monomers directly. The image, normalized to the water signal, was converted into an absolute dose map. At the isocentre the measured dose was 5.69 Gy (SD = 0.09) which was in good agreement with the planned dose. The measured dose distribution elsewhere in the sample shows greater errors. A T2 derived dose map demonstrated a better relative distribution but gave an overestimate of the dose at isocentre of 18%. The data indicate that MR measurements of monomer concentration can complement T2-based measurements and can be used to verify absolute dose. Compared with the more usual T2 measurements for assessing gel polymerization, monomer concentration analysis is less sensitive to parameters such as gel pH and temperature, which can cause ambiguous relaxation time measurements and erroneous absolute dose calculations.

Calibration↗
PubMed1980

Unusual presentation of severe hypoglycemia.

An unusual case of severe hypoglycemia during which a patient was awake and able to walk despite a serum glucose concentration of 10 mg/dl (0.55 mmol/l) is reported. No tumor was found at autopsy, and the patient was not diabetic. Repeat glucose determinations on the initial as well as subsequent blood samples and a mixing study were performed to exclude interference and sampling or analytic error. The discrepancy between the clinical status of the patient and the degree of hypoglycemia remains an enigma.

Aged↗

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