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PubMed1999

Discrepancies between standardized measures of cognitive level and Halstead-Reitan impairment indices as inferences of brain damage following head injuries.

z scores for measures of intelligence, memory, educational achievement, and neuropsychological impairment were obtained for 193 patients who had sustained impacts of mechanical energy to their skulls. Two sets of normative data, adjusted for age and sex and not adjusted for these variables, were employed to compute indices of neurocognitive proficiency (the inverse of impairment). 80% or 76 of the 96 patients whose Halstead-Reitan Indices were greater than 0.4 displayed scores for neurocognitive proficiency that were two or more standard deviations below the averages of their scores for intelligence, memory, and educational achievement. None of the patents whose Impairment Indices were 0.4 or less displayed this discrepancy. There were no statistically significant differences between these two groups of patients with respect to the presence of unconsciousness following the injury or the duration of posttraumatic memory disruptions. The results indicate that quantitative scores for neuropsychological impairments are still the most accurate criteria to discern brain dysfunction within the mild to moderate range.

Adolescent↗
PubMed1998

Physical therapy and health-related outcomes for patients with common orthopaedic diagnoses.

Assessing both physical and mental health is necessary in clinical settings to quantify the scope of disability and to evaluate the effectiveness of treatment programs. Changes in health-related quality of life following physical therapy treatment for many patients with orthopaedic-related diagnoses is not known. The purposes of this study were to describe changes in health-related quality of life between the initial assessment and the time of discharge from physical therapy for the most common orthopaedic diagnoses and to compare the patterns of deficit among diagnostic categories. Patient outcomes in this study were evaluated from a large database generated by the Focus on Therapeutic Outcomes (FOTO) network. Health-related and employment outcomes were described for adult patients who were classified using ICD-9-CM codes. The most common orthopaedic diagnostic categories were sacroiliac sprain, back sprain, low back pain (radiating and nonradiating), neck sprain, neck pain (radiating and nonradiating), adhesive capsulitis of the shoulder, rotator cuff injury, shoulder sprain, knee dislocation, knee sprain, and knee derangement. The primary outcome measure was a 17-item questionnaire (the MOS-17) derived from the RAND 36-Item Health Survey (SF-36) and the 12-item Short Form Health Survey (SF-12). The comparison of each cohort to population norms was made by calculating a standard score on patient data adjusted for age and gender. An effect size was calculated to measure the change in health or employment status between the initial assessment and discharge from physical therapy. For all diagnostic categories, health-related quality of life with respect to norms and employment status showed a consistent pattern of improvement at the time of discharge compared with the initial assessment. There were only small changes in physical function for neck and shoulder diagnostic categories. Nearly all of the diagnostic categories had large reductions in bodily pain. The amount of clinical change in the physical components of health-related quality of life--especially the physical function and role physical domains--differed substantially across specific diagnostic categories. The largest improvements in the physical function occurred for patients with knee dislocation and knee sprain. Patients with knee dislocation also had the largest improvement in role limitations due to physical problems. The design of this study does not permit conclusions about the efficacy of physical therapy. Further study is needed to determine if the finding of different levels of health status improvement across diagnostic categories was due to the nature of the outcome measure, the type of treatments given to each patient, or other confounding variables, like depression or preinjury functional level.

Adult↗
PubMed2001

Alkanes as internal markers to estimate digestibility of hay or hay plus concentrate diets in horses.

Dry matter intake (DMI), dry matter digestibility (DMD), and fecal output (FO) are difficult to measure directly in the field, and indirect methods using external and internal markers have thus been developed. An experiment was conducted consisting of two digestion trials with two periods in each trial to examine the use of five odd-chain alkanes (C25 to C33) of plant cuticular wax as internal markers to estimate DMD of hay or hay plus concentrate diets in horses. Eight mature Thoroughbred geldings were housed in 4- x 4-m stalls and randomly assigned to one of two mixed grass/legume hays (Diets 1 and 2) in Trial 1 and to mixed grass/legume hay plus one of two concentrates (Diets 3 and 4) in Trial 2. After the first 12-d period was conducted, dietary assignments for each group were switched for the second period in each trial. Each period consisted of a dietary accommodation from d 1 to 7 and total fecal collection from d 8 to 11. Results indicated that fecal recoveries of odd-chain alkanes were 88 to 90% for Diet 1, 75 to 92% for Diet 2, 71 to 81% for Diet 3, and 71 to 82% for Diet 4. Alkane recoveries were not related to alkane chain lengths. Digestibilities calculated from alkane concentration data adjusted using the mean fecal recovery of individual odd-chain alkanes (DA1) were not significantly different from the digestibilities estimated from total collection (DTC) for Diets 1 and 2 in Trial 1 and Diets 3 and 4 in Trial 2. When adjustment was based on the mean recovery of all alkanes (DA2; estimated by linear regression), all DA2 estimates for horses offered all diets were similar to DTC. Results indicate that accurate mean estimates of DMD can be obtained by using plant wax alkane markers and adjusting for the mean recovery of five odd-chain alkanes in a diet.

Alkanes↗
PubMed2001

Refinements in primary rumen epithelial cell incubation techniques.

The objectives of this study were to 1) determine if the number of rumen epithelial cells in primary cell incubation affects the rate of metabolite production, and 2) determine the optimum mode of data expression to standardize reporting criteria. Sections of rumen epithelial tissue were excised from five Holstein heifers and subjected to serial tryptic digestion to isolate cells. Isolated cells had a mean viability of 86% (+/- 1.29) and were incubated at concentrations of 0.5, 1, 5, 10, 20, and 40 million cells per flask. Oxidation of [1-14C]butyrate to 14CO2 and production of acetoacetate (ACAC), beta-hydroxybutyrate (BHBA), lactate, and pyruvate were measured for cell dilution comparisons. Cell number, cell dry matter, cell crude protein, epithelial wet tissue weight, body weight, and metabolic body weight were measured to generate 12 different forms of data expression. Coefficients of variation were calculated for each type of expression. Expressing data per cell number resulted in the lowest variation. Oxidation of [1-14C]butyrate to 14CO2 and pyruvate production per million cells did not significantly differ between treatments for 90-min incubation. Acetoacetate and lactate concentrations were greatest at 0.5 and 1 million cells/flask, respectively, with no differences between 5 to 40 million cells/flask. Production of BHBA for 1 million cells/flask was greater than 0.5 and 40 million cells/flask, but did not change between cell concentrations 5 to 20 million. The BHBA:ACAC concentration ratios for 0.5 and 1 million cell dilutions were both 1.1 to 1 indicating low mitochondrial redox potentials. Concomitantly, lactate:pyruvate ratios for 0.5 and 1 million cells were greater than other cell dilutions, indicating a high cytosolic redox potential. The suggested range of rumen epithelial cells to include in incubations is 5 to 20 million cells/flask. This will minimize experimental error associated with using low cell numbers and the potential for reduced metabolite production caused by incubating large cell quantities. When rumen tissue taken from animals of the same species, size, and stage of development; data adjusted by cell number is preferred. However, it is recommended that cell protein, cell DM, and animal metabolic weight be included to facilitate future comparison between species and laboratories.

Animals↗
PubMed1985

Interaction of protein percent with caloric density and protein source for lactating cows.

Experiment 1 was to test effect of three ratios of energy to protein in complete mixed diets for 36 lactating cows in three, 28-d periods. Energy was varied with cottonseed hulls, pelleted ground corrugated boxes, and a mixture of the two. Crude protein was varied with soybean meal to give energy:crude protein of 5.7, 5.0, and 4.6 for each energy amount. Cottonseed meal was compared with soybean meal in corrugated box diets. Feed intake was much higher with cottonseed hulls, and appreciable feedlot bloat resulted from pelleted ground corrugated box diets. Data adjusted to equal feed intake showed significant effect of energy to crude protein ratio on milk yield and improved digestion of organic matter with soybean meal vs. cottonseed meal. Experiment 2 tested the hypothesis that lactating cows consuming high-protein alfalfa may benefit from supplemental protein. Diets were 50% forage. Six diets were 14 or 18% crude protein in three ratios of alfalfa hay to corn silage (0:100, 50:50, 100:0). Additional corn silage diets were to compare: 14 versus 18% protein from distiller's dried grains with solubles only and with .5 or .9% urea (four diets); two 14% protein diets compared .6% added potassium chloride with or without .5% urea. Thirty-six Holstein cows in early lactation received one of the 12 diets in each of three 28-d periods. Distiller's grains with solubles markedly depressed milk yield (2.2 kg/d) and milk protein (.22%); heat damage of distiller's grains was evident. Protein interacted with alfalfa so gain in milk from 18 versus 14% increased from .55 to 1.36 to 2.66 kg/d as alfalfa changed from 0 to 50 to 100%. Thus, crude protein of alfalfa was not as effective as that from soybean meal in supporting milk yield.

Animal Feed↗
PubMed1994

Direct analysis of body composition of dairy cows at three physiological stages.

Holstein cows were killed at three physiological stages, prepartum (-7 d, n = 10), early lactation (63 d, n = 7), and late lactation (269 d, n = 8), for determination of chemical composition and prediction of energy changes during lactation. Cows were weighed, slaughtered, and separated into five or six fractions, including carcass, gastrointestinal tract, mammary gland, uterus, and fetus (if present); the remainder was noncarcass. Live BW and weight of all empty body components except fat were unaffected by physiological stage. Empty body fat was reduced 42.3 kg for the early lactation cows compared with that of prepartum cows. Fat-free matter was similar across physiological stages; however, the water content of fat-free matter was greater for the prepartum and early lactation cows than for late lactation cows. In early lactation cows, the percentages of total protein were less in carcass and greater in gastrointestinal tissue than in prepartum and late lactation cows, but fat distribution was not affected. The energy values of 9.2 and 5.57 Mcal/kg for fat and protein in tissue, respectively, were determined by regression and used to apportion energy associated with fat, .925, and protein, .07, during lactation using data adjusted for ash. A maximum loss of 442 Mcal of tissue energy by approximately 77 DIM was determined by regression of empty body energy on DIM).

Animals↗
PubMed1991

[Morphometric analysis of normal human sural nerves for systematic clinical application].

To obtain normative data on the sural nerve for clinical evaluation of the pathologic process and severity of the various peripheral nerve disorders, a morphometric analysis was made on 30 control sural nerves from normal volunteers, and from patients and cadavers with no evidence of peripheral nerve involvement. The ages of volunteers, patients and cadavers ranged from 13 to 83 years. The data obtained included 1) the mean frequency of abnormal teased myelinated fibers and its upper limit value of 95% confidence interval, and 2) the mean densities of total, large and small myelinated fibers and of unmyelinated fibers and their lower limit value of 95% confidence interval for each decade. The linear correlation between the age and each of the frequencies of abnormal teased myelinated fibers and the densities of total, large and small myelinated fibers and of unmyelinated fibers were statistically significant (P less than 0.01). Therefore, the morphometric data obtained from the disease nerve should be compared with the normative data adjusted for the age of the subject described in this study.

Adolescent↗
PubMed1992

[Cutaneous thermal-cooling and -warming detection thresholds in distal extremities of normal subjects].

The cutaneous thermal-cooling and -warming detection thresholds were evaluated on the dorsal side of the right distal forearm and on the dorsum of the right foot in 134 normal subjects (66 men and 68 women) without sensory symptoms and signs, aged from 11 to 87 years by using a Thermal Threshold Tester (Vickers Medical International, England). The normative data for the clinical evaluation of the severity and the pathologic process of the sensory disturbance of the patients were obtained. The data obtained included 1) the mean of each threshold and 2) its upper limit value of 95% confidence interval for each decade. The mean of each threshold was significantly increased with aging (P less than 0.0001). Therefore, the cutaneous thermal-cooling and -warming detection thresholds of the patients with sensory disturbances should be compared with the normative data adjusted for the age of each subject obtained in this study. Based on the evaluation, repeated six times for three weeks, of each threshold of six volunteers (ages from 21 to 66), high reliability of each threshold (intraclass correlation coefficient from 0.78 to 0.96) was observed.

Adolescent↗
PubMed1999

Radiographic measurement of craniocaudal instability in stifle joints of clinically normal dogs and dogs with injury of a cranial cruciate ligament.

OBJECTIVE: To determine craniocaudal laxity of the stifle joint of dogs when joints were positioned in tibial compression or neutral position. SAMPLE POPULATION: 19 normal stifle joints in 10 clinically normal dogs, 29 stifle joints with varying injury to the cranial cruciate ligament (10 complete ruptures alone, 10 complete ruptures with concomitant damage to the medial meniscus, 6 partial ruptures alone, and 3 partial ruptures with concomitant meniscal tearing), and 19 unaffected contralateral stifle joints in those 29 dogs. PROCEDURE: Relative displacement of bony landmarks was measured on paired lateral radiographs (neutral and tibial compression positions). Two measuring techniques were customized for use in dogs. RESULTS: The first technique failed to distinguish results in normal stifle joints from those in stifle joints with partial deficiency of cranial cruciate ligaments. Significant differences were found for joints with complete rupture, compared with stifle joints in clinically normal dogs. The second technique detected differences between normal stifle joints and injured joints with partial or complete rupture of the cranial cruciate ligament. Significant differences were not detected between joints with partial versus complete rupture. Adjusting data to account for size of dog did not improve results. CONCLUSIONS AND CLINICAL RELEVANCE: A wide range in measurements of laxity was found for stifle joints with intact cranial cruciate ligaments. Differences in degree of damage to the ligament and medial meniscus cannot be deduced from the amount of relative displacement measured on radiographs. Pathologic changes to the cranial cruciate ligament will not necessarily induce detectable changes in laxity of stifle joints in dogs.

Animals↗
PubMed2000

Epidemiology of sarcopenia.

OBJECTIVES: To examine patterns of muscle mass change with aging and to estimate the prevalence of sarcopenia. DESIGN: Cross-sectional survey. SETTING: Population-based study in Rochester, Minnesota. PARTICIPANTS: Age-stratified sample of men and women from the community. MEASUREMENTS: Muscle mass estimated from total body scans by dual-energy X-ray absorptiometry. Sarcopenia was defined as muscle mass more than 2 standard deviations below the sex-specific young-normal mean. RESULTS: Total lean body mass (exclusive of bone) and total skeletal muscle mass both were greater in men than women and declined linearly with age as judged from these cross-sectional data. Adjustment for height reduced the gender difference. The age- and sex-adjusted prevalence of sarcopenia varied from 6 to 15% among subjects 65 years of age or over, depending on the muscle mass parameter that was evaluated, but prevalence rates were quite sensitive to the normal values used to define cutoff levels. Subjects with sarcopenia appeared to have more physical limitations than the others. CONCLUSIONS: Late in life, a substantial portion of the population reaches low levels of muscle mass that are associated with increased physical disability. However, additional efforts are needed to validate an operational definition of sarcopenia.

Absorptiometry, Photon↗
PubMed2000

DiasNet--an Internet tool for communication and education in diabetes.

Although studies have shown that intensive diabetes treatment with the goal of maintaining blood glucose concentrations close to the normal range lead to a substantial reduction of the rate of the complications (e.g. blindness, kidney failure, amputations and circulatory diseases), this can be difficult to achieve using conventional means. It is recognised that a number of patients may have poor control despite specialist care, and this along with devolution of care to non-specialists suggests that alternative interventions should be developed. DiasNet, which is used by patients as a tool for education and communication, is based on a well documented decision support system used by clinicians to give advise on insulin dose. In DiasNet the patients can experiment with their own data, adjusting insulin doses or meals sizes, and thereby learning how to cope with various situations. The system can run both as an ordinary application on a standard PC, and as an Internet application using a standard web browser. The latter enables a new way of communication between patient and clinician. DiasNet is currently being tested on a small group of diabetes patients.

Blood Glucose↗
PubMed2002

Thrombolysis for acute myocardial infarction: drug review.

The proof of efficacy of thrombolysis for acute myocardial infarction (AMI) depends on 9 randomized placebo-controlled trials totaling 58,511 patients. The meta-analysis of these trials showed an overall survival advantage of about 2% (11.5% vs 9.6%) in favor of thrombolysis. Iatrogenic deaths from thrombolysis complications occur in about 1% of AMI patients. Timely opening of the infarct-related artery (IRA) allowing myocardial reperfusion has been proposed to explain any survival advantage seen with thrombolysis ("open-artery hypothesis"). Angiographic data does not support the open-artery hypothesis as the mechanism of any benefit of thrombolysis. The "early hazard" (ie, increased mortality in the first 12 hours after thrombolysis) also suggests that the supposed survival benefit is due to something other than early reperfusion. The variable use of aspirin in the meta-analysis trials may have confounded the results and conclusions. In the 4 studies of the meta-analysis in which aspirin was used routinely (n = 21,144), the survival benefit was not statistically significant (P =.14). Lack of blinding in some studies and other methodologic problems may also call the conclusions of the meta-analysis into question. AMI registry reports comparing patients with and without thrombolysis have not borne out a significant survival advantage with thrombolysis. The National Registry of Myocardial Infarction (NRMI) registry data suggest that a significant number of AMI patients may be inappropriately receiving thrombolytics. An independent analysis of the NRMI mortality data adjusted for age and other risk factors would help determine whether thrombolysis for AMI improves survival.

Cost-Benefit Analysis↗
PubMed1998

Effect of estrogen supplementation on periodontal disease.

This article presents evidence of the protective role of estrogen supplementation on periodontal disease in postmenopausal women. A total of 412 women, 236 postmenopausal (50 to 75 years old) and 176 premenopausal (25 to 49 years old), were included in this study. The postmenopausal group included 59 women receiving estrogen replacement therapy (ERT) and 177 who did not receive ERT (non-ERT). Periodontal disease was assessed from two independent but highly correlated measures: clinical attachment loss (CAL) and alveolar bone loss (ABL). Severe periodontal disease was arbitrarily defined as mean CAL or ABL > or = 3 mm. Data adjusted for age effect were compared for various groups of premenopausal and postmenopausal women. Non-ERT women were twice as likely as their ERT counterparts, and three times more likely than premenopausal women, to exhibit severe attachment loss. Individual percentages of women affected by severe attachment loss were 18.6%, 11.9%, and 6.3% for non-ERT, ERT, and premenopausal women, respectively. On the other hand, severe ABL was detected in 34%, 20.3%, and 9.7% of the non-ERT, postmenopausal ERT, and premenopausal women, respectively. Similar to CAL, when ABL was used as a measure of disease, almost twice as many non-ERT women compared to their ERT counterparts and four times compared to premenopausal women exhibited severe ABL. Therefore, ERT appears to have a protective effect on the severity of periodontal disease and the periodontium.

Adult↗
PubMed1993

Using information from demographic analysis in post-enumeration survey estimation.

"Population estimates from the 1990 Post-Enumeration Survey (PES), used to measure decennial census undercount, were obtained from dual system estimates (DSE's) that assumed independence within strata defined by age-race-sex-geography and other variables. We make this independence assumption for females, but develop methods to avoid the independence assumption for males within strata by using national level sex ratios from demographic analysis (DA).... We consider several...alternative DSE's, and use DA results for 1990 to apply them to data from the 1990 U.S. census and PES."

Americas↗
PubMed1993

Estimating heterogeneity in the probabilities of enumeration for dual-system estimation.

"We show how conditional logistic regression can be used to estimate the probability of being enumerated in a census and apply the model to the 1990 Post-Enumeration Survey (PES) in the United States.... We discuss some special problems caused by the fact that the PES sample area is open to migration between the captures. We also consider the effect of data errors in estimation. We characterize hard-to-enumerate populations and give some tentative estimates of correlation bias."

Americas↗
PubMed1993

A three-sample multiple-recapture approach to census population estimation with heterogeneous catchability.

"A central assumption in the standard capture-recapture approach to the estimation of the size of a closed population is the homogeneity of the 'capture' probabilities. In this article we develop an approach that allows for varying susceptibility to capture through individual parameters using a variant of the Rasch model from psychological measurement situations. Our approach requires an additional recapture. In the context of census undercount estimation, this requirement amounts to the use of a second independent sample or alternative data source to be matched with census and Post-Enumeration Survey (PES) data.... We illustrate [our] models and their estimation using data from a 1988 dress-rehearsal study for the 1990 census conducted by the U.S. Bureau of the Census, which explored the use of administrative data as a supplement to the PES. The article includes a discussion of extensions and related models."

Americas↗