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At least 343 records · Page 19Linked to original sources

Standardized analysis for the quantification of Vbeta CDR3 T-cell receptor diversity.

Assessment of the diversity of the T-cell receptor (TCR) repertoire is often determined by measuring the frequency and distribution of individually rearranged TCRs in a population of T cells. Spectratyping is a common method used to measure TCR repertoire diversity, which examines genetic variation in the third complementarity-determining region (CDR3) region of the TCR Vbeta chain using RT-PCR length-distribution analysis. A variety of methods are currently used to analyze spectratype data including subjective visual measures, qualitative counting measures, and semi-quantitative measures that compare the original data to a standard, control data set. Two major limitations exist for most of these approaches: data files become very wieldy and difficult to manage, and current analytic methods generate data which are difficult to compare between laboratories and across different platforms. Here, we introduce a highly efficient method of analysis that is based upon a normal theoretical Gaussian distribution observed in cord blood and recent thymic emigrants. Using this analysis method, we demonstrate that PBMC obtained from patients with various diseases have skewed TCR repertoire profiles. Upon in vitro activation with anti-CD3 and anti-CD28 coated beads (Xcyte Dynabeads) TCR diversity was restored. Moreover, changes in the TCR repertoire were dynamic in vivo. We demonstrate that use of this streamlined method of analysis in concert with a flexible software package makes quantitative assessment of TCR repertoire diversity straightforward and reproducible, enabling reliable comparisons of diversity values between laboratories and over-time to further collaborative efforts. Analysis of TCR repertoire by such an approach may be valuable in the clinical setting, both for prognostic potential and measuring clinical responses to therapy.

Complementarity Determining Regions↗

The effect of state medicaid case-mix payment on nursing home resident acuity.

OBJECTIVE: To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. DATA SOURCES: Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. STUDY DESIGN: We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. DATA COLLECTION/EXTRACTION METHODS: We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. PRINCIPAL FINDINGS: Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. CONCLUSIONS: The adoption of case-mix payment increased access to care for higher acuity Medicaid residents.

Diagnosis-Related Groups↗

Benchmark data outlined on senior surgery utilization.

Data File: The Center for Health Care Statistics in Hyattsville, MD, has released benchmark data on surgery visits by seniors, reporting that seniors have 3.5 times as many surgery visits as younger patients. To manage your Medicare surgery utilization, find out what the top diagnoses and procedures are for those visits.

Aged↗

Incidence and tumour stages of breast cancer in the region of Aachen, Germany.

We present epidemiological data of female breast cancer in the region of Aachen (Germany) including incidence and tumour stages for the period 1996-1997. Furthermore, we compare epidemiological data from Aachen with data from the directly neighbouring Dutch region South-Middle Limburg before and after the introduction of a national mammographic screening programme. The field study of breast cancer was undertaken at the Institute of Pathology and Comprehensive Cancer Center at the University of Aachen, supported by the Federal Ministry of Health (Germany), using data files from the Cancer Registry Aachen. The patient's consent to collect all data concerning her epidemiological and social situation as well as information on the outcome of disease was obtained in 83.4% of all cases. The remaining 16.6% of the cases without a patient's consent are based on histopathological reports. Only those patients are included who were documented as residing in the region of Aachen at the time of diagnosis. Tumour cases were counted according to International Agency for Research on Cancer rules and tumour stages are classified according to UICC guidelines. Incidence rates are calculated as crude value, adapted to the European and World Standard population (ESR, WSR), and the age specific incidence is presented in 5-year intervals. The cumulative risk is assessed for a certain life span by summarizing the age-specific incidences. The age-standardized breast cancer incidence rate in Aachen was 94 per 100 000 women in 1996 and 90 cases of invasive breast cancer per 100 000 women in 1997 according to the ESR. The cumulative risk of developing breast cancer in the life span ranging from 0 to 74 years is approximately 8%. The stage distribution of breast cancer reveals only 4% favourable carcinomata in situ, but 12% advanced T4 tumours. T1 and T2 tumour stages count for about 40% and T3 tumour stages about 4%. Incidence rates and the tumour stages of breast cancer in the region of Aachen during 1996 and 1997 are similar to the data obtained from the directly neighbouring Cancer Center of the region South-Middle Limburg, in the Netherlands, in 1989/1990 before the beginning of the national breast cancer screening programme. However, major differences are found in terms of the incidence and the tumour stages between Aachen 1996/1997 and South-Middle Limburg 1995/1996 after the introduction of the mammographic screening. The incidence of female breast cancer in Aachen, Germany, was high and in the range of the data from other cancer registries in Europe without national screening programmes. The tumour stages at diagnosis in Aachen were not very favourable, especially in elderly women. An increase of the cancer incidence and a shift of the tumour stages to more favourable ones were observed in the neighbouring Dutch region of South-Middle Limburg, comparing data from 1989/90 and 1995/96. This is probably as a result of the national mammographic screening programme. As data from Aachen were similar to Limburg's data from 1989/90 before the mammographic screening was introduced, it will be important to follow and compare the cancer incidence and the tumour stages in the future.

Breast Neoplasms↗

Use of generic software programs in management of patient records and clinical research.

As personal computers become more cost-effective and user-friendly, they are bound to play an increasing role in the practice of medicine. This article is a description of how a commercially available database system adapted for medical record keeping has greatly facilitated the storage and retrieval of information. The designation of a data file for storage of patient records through the use of the systems menus, data entry, and conduct of searches for particular bits of data are described. Unique features such as custom-tailored computer reminders and project-specific programming are recommended as ways to improve the effectiveness of patient care and clinical research. When a single database system is used, the cost in terms of time, money and expertise is dramatically decreased, allowing the physician to optimize all aspects of the practice of medicine of exploiting computer technology with minimal to no knowledge of computer languages and/or programming.

Gynecology↗

Occupational mortality and cancer analysis.

The 1970-census populations have been followed up for deaths and emigrations in the ten-year period 1970-80 in all the Nordic countries. The data show more than a 2-fold difference in overall mortality between the low-risk group of men with pedagogical work and the high-risk group of deck and engine crew workers. These data files have also been supplemented with cancer register records. In Denmark this combined data set has been used in four different ways. First, in order to check the validity of the register, classic associations known from in-depth epidemiological studies were tabulated. Examples are cancer of the lip in farmers and fishermen, where the standardized incidence ratio (SIR) values were 1.85 and 3.17, respectively, and cancer of the nasal cavities and sinuses in skilled furniture makers, SIR = 12.25. Second, a social cancer map was produced by tabulating the cancer incidence by 20 socioeconomic groups. The social gradient was steepest for certain rare cancers related to specific etiologic factors. The social gradient also varied across cancer sites. Third, the register was used as a library for elucidation of newly reported associations. An association confirmed in the Danish data is an excess risk of bladder cancer in hairdressers, SIR = 2.05. An unconfirmed example is an excess risk of malignant melanoma in the printing industry, where Danish data show an SIR of 0.95. Fourth, a systematic tabulation of each cancer diagnosis across detailed occupational groups may lead to identification of previously unknown associations. This procedure is illustrated using cancer of the larynx as an example. Smiths, mechanics, foremen, and shop owners of engineering works and workshops all have an excess risk of laryngeal cancer, SIR = 1.63.

Denmark↗

[Fatal shotgun use in peace time].

On the suggestion of Conzelmann et al. (1977) and Lerch (1982), 176 shooting fatalities with 249 shot wounds in the South Baden region were evaluated in a multi-dimensional analysis of such data as place of death, autopsy findings, forensic examinations, and police and court files. Data were collected on incident, victim, culprit, weapon used, motive and the special circumstances of each case. The greatest number of deaths are suicides of inebriated men using handguns of medium-size caliber (7.65 and 9 mm), followed by homicidal shooting deaths, some involving multiple shots at longer range, though one-third were at close range. 78% of the shots fired from rifles and shotguns were in connection with suicides, 50% involved small-caliber weapon, 86% of the victims were men. Only 7% of the 131 shooting suicides, but 36% of the 39 homicides, involved women. 58% of the women who died a shooting death were victims (not seldom followed by their mates committing suicide), men were victims in only 17% of the cases. 98% of the suicidal and one-third of the homicidal shots were fired at close range. Rifles or shotguns were used in 12% of the homicides, but also in 27% of the suicides. Yet according to witnesses, every 10th victim, though mortally wounded in the head, chest, or abdomen, was still capable of action for some time. Every 7th suicides was still clutching the weapon after death. Half of the suicides involving unusual shots were committed by women. In 50% of the homicides, the killer was either the mate or a relative of the victim, was between 40 and 60 years of age, and committed suicide after shooting his mate. In 78% of the cases, killer and victim knew each other. Two-thirds of all the suicides occurred in the home, with the bedroom being the preferred scene in 25% of the cases.

Adolescent↗

Neighborhood social context and racial differences in women's heart disease mortality.

Compared to white women, black women experience similar rates of heart disease morbidity, but higher rates of heart disease mortality. This puzzling relationship may be due to several factors working at varied levels to affect each race. For example, the high heart disease mortality rate may be due to individual health or socioeconomic risk factors or to social structural factors. We conduct a multi-level analysis to address these issues, using data from a newly released data file that links the National Health Interview Survey with death certificate information from the National Death Index, and with additional community level data from the 1990 Census STF-3A files. We are primarily interested in the effects of female-headship rates in the census tracts on coronary heart disease mortality (CHD) among black and white women. We find that women who live in communities with high concentrations of female-headed families are more likely to die of heart disease, net of other characteristics. For younger women, the effect appears to be routed primarily through poverty whereas for older women the effect of female-headship rates remains, net of other census tract characteristics. This study, then, highlights the importance of examining the effect of neighborhoods and their social content on mortality.

Adolescent↗

The combination of radiotherapy and surgery in the treatment of carcinoma of the uterine cervix.

In the Department of Radiotherapy and Oncology at Oxford, 1303 patients were registered between 1950 and 1975 with a diagnosis of carcinoma of the uterus; from these, 883 cases of carcinoma of the uterine cervix could be identified with certainty. Each patient's full clinical record was established from multiple hospital notes, operating theatre records, histopathological report files and so on. A uniform classification, based on the TNM system, was used for all patients. A data file, suitable for computer analysis, was established which contained all the available data. Analysis revealed that all patients could be divided into two distinct groups that had been prospectively determined and that the allocation achieved was random. The results, by various methods of analysis, show consistently that a policy of radical radiotherapy combined with radical surgery gave an increased survival rate, and a decreased mortality rate from cancer when compared with a treatment policy of only radical radiotherapy. During the 25 years being reviewed there was a progressive increase in the number of young patients with cancer of the uterine cervix in the early stages of disease at presentation and in the survival of patients with the early stages of invasive cancer.

Adult↗

Coverage of emergency after-hours ultrasound cases: survey of practices at U.S. Teaching hospitals.

RATIONALE AND OBJECTIVES: Diagnostic ultrasound examinations may be performed after-hours by physicians if technologists are not available or cases are complex. Our experience suggested there is wide variability in how ultrasound coverage is provided after-hours, which motivated us to conduct a formal survey of teaching programs around the country. METHODS: Four hundred five members of the Association of Program Directors in Radiology were contacted by e-mail and sent a link to a five-part questionnaire posted on the Web. Respondents were asked whether ultrasound cases after-hours are performed in their institutions by radiology residents, technologists on the premises after-hours, technologists on-call, or some combination. Data on the type of program, number of beds in the primary hospital, number of residents in the program, and geographic location of the program were recorded. Responses were automatically written to a data file stored on a Web server and the imported into an Excel spreadsheet for data analysis. A chi(2) analysis was performed to assess associations among the variables and statistical significance. RESULTS: A total of 79 programs responded to the survey. Of those, 32% provided coverage with ultrasound technologists on call, 24% by ultrasound technologists on the premises, 13% provided combination coverage, and 10% provided coverage solely with residents on call. There was no association among number of residents in the program, location of the program, or type of program (university, community, or affiliated) and type of coverage provided. CONCLUSION: There is wide variability in methods for providing coverage of after-hours ultrasound cases. However, on-site or on-call coverage of emergency cases by technologists did not appear to depend significantly on program location, program type, or program size.

After-Hours Care↗

Communities and hospitals: social capital, community accountability, and service provision in U.S. community hospitals.

OBJECTIVES: The study related community social capital to the level of community accountability and provision of community-oriented services in U.S. community hospitals. STUDY SETTING: The sample included 1,383 community hospitals that participated in the 1997 American Hospital Association's (AHA) Hospital Annual and Governance Surveys. DATA SOURCES: (1) The 1997 AHA Annual Hospital Survey, (2) the 1997 AHA Hospital Governance Survey, (3) the DDB Needham Market Facts Survey, (4) the 1996 County Election Data File, and (5) the 1998 Area Resource File. RESEARCH DESIGN: The study used a mix of longitudinal and cross-sectional data. KEY FINDINGS: We identified two distinct indicators of social capital-community participation and voting participation. Community accountability in hospitals was unrelated to either indicator. Hospitals' provision of community-oriented health services was negatively associated with community participation but unrelated with voting participation. The interaction between voting participation and community representation on hospital governance was positively associated with community accountability and provision of community-oriented health services. CONCLUSION: Neither community participation nor voting participation was sufficient to influence hospital behavior. The positive finding associated with the interaction between voting participation and community representation on hospital governance underscored the importance of an active political culture in influencing hospital behavior, without which the installation of community representatives on hospital governance might be more symbolic than actually serving the health concerns of community residents.

Catchment Area, Health↗

The pharmacy computer system at the New England Medical Center.

The pharmacy computer system developed and implemented at the New England Medical Center (NEMC) is described. The system was developed to improve the department's fiscal performance and operations. It operates on NEMC's large mainframe system and has the following components-order entry, unit dose/patient profile, i.v. admixture, and financial/management. The system was designed to interface with the admissions and census system and use the pharmacy department's drug data file. It accepts medication orders from pharmacy satellites and then processes the orders according to the requirements for the i.v. admixture or unit dose procedures. Financial data are collected as a routine part of all medication order processing. The system allows for the entry of multiple medication orders on one cathode ray tube (CRT) screen, thus facilitating order entry. The use of programmed system defaults is described. Order entry, dose selection, and patient profiles are displayed on a CRT. An active order list is printed once daily at midnight to serve as a back-up for the system. The computer system has had a positive impact on the department's operational, clinical, and management functions. Future enhancements of the NEMC system are discussed.

Allied Health Personnel↗

An integrated multielectrode electrophysiology system.

An integrated system for recording and analyzing electrophysiological data from multiple channels is described. The system uses an MS-DOS microcomputer, a 16-channel amplifier, and multiple-tipped electrode arrays designed for use in intact and slice preparations. The system is designed for applications where the collection and analysis of multiple-channel electrophysiological data is desirable, including the construction of current source density (CSD) profiles from field potential data. The software incorporates on-line averaging, CSD and freeze-frame capabilities to guide the experiment in progress. Additional off-line analyses include multiple unit activity, power spectra, and automatic scans of data files for peak amplitude, area, latency, and slope within user-defined latency windows. All data and analyses can be exported to commercial statistical/graphical programs for the creation of publication-ready figures.

Amplifiers, Electronic↗

Sex differences in COPD and lung cancer mortality trends--United States, 1968-1999.

PURPOSE: Cigarette smoking by U.S. women in the 1940s and 1950s caused large increases in smoking-related lung disease among women. To determine the magnitude of these increases, we compared the mortality trends for males and females in the United States for chronic obstructive pulmonary disease (COPD) and lung cancer for 1968-1999. METHODS: We used the national mortality data files compiled by the National Center for Health Statistics of the CDC and U.S. census data to calculate age-adjusted (2000) death rates for COPD, lung cancer, and all causes. RESULTS: COPD death rate for females increased by 382% from 1968 through 1999, whereas for males it increased by 27% during the same period. As a result, the COPD death rate for U.S. females is approaching that for males. The lung cancer death rate for females increased by 266% from 1968 to 1999, whereas for males, it increased by 15%. CONCLUSIONS: Physicians, women, and groups interested in women's health issues need to be aware of these trends and target prevention strategies toward females.

Female↗

Method for assessing food intakes in terms of servings based on food guidance.

We describe a method for comparing food intakes reported in surveys with recommendations given in the US Department of Agriculture's food guide pyramid. Such comparison was previously difficult because many foods are eaten as mixtures that cannot be categorized into pyramid food groups and because food intake data and food recommendations are expressed in different units of measurement. We developed a recipe file showing ingredients at multiple levels of breakdown and used it to disaggregate food mixtures into their ingredients so that they could be placed into pyramid food groups. Food-specific weight consistent with the pyramid definitions for serving sizes were derived from the food code book of the 1989-1991 Continuing Survey of Food Intakes by Individuals and used to develop a serving-weight file. Data collected from 8181 adults aged > or = 20 y in the survey were used to estimate the mean number of servings from pyramid food groups and percentages of the population meeting pyramid recommendations. The mean numbers of servings were close to the minimum recommendations for the grain, vegetable, and meat groups and well below the minimum recommendations for the fruit and dairy groups. large proportions of adults (43-72%) failed to meet the dietary recommendations. Our method has several nutrition monitoring and nutrition education applications.

Adult↗

The national survey of children with special health care needs.

CONTEXT: The federal and state-level Children with Special Health Care Needs (CSHCN) programs are vested with the responsibility for planning and developing systems of care for children with special health care needs. To support achievement of this goal, the federal Maternal and Child Health Bureau (MCHB), in partnership with the National Center for Health Statistics (NCHS), has developed a new survey that will provide uniform national and state data on the prevalence and impact of special health care needs among children. PURPOSE: The National Survey of CSHCN is designed to produce reliable state- and national-level estimates of the prevalence of special health care needs using MCHB's definition of CSHCN. It will also provide baseline estimates for federal and state Title V Maternal and Child Health performance measures, for Healthy People 2010 national prevention objectives, and for each state's Title V needs assessment. In addition, it will provide a resource for researchers, advocacy groups, and other interested parties. It is anticipated that this survey will be repeated periodically, thereby making trend analysis possible. METHODS: This survey is being conducted using the State and Local Area Integrated Telephone Survey mechanism, which shares the random-digit-dial sampling frame of the National Immunization Survey (sponsored by the National Immunization Program and NCHS). Using the CSHCN Screener, developed under the auspices of the Foundation for Accountability, 750 children with special health care needs will be identified and selected from each state and from the District of Columbia. Parents or guardians of these children then complete a comprehensive battery of questions on demographics, health and functional status, health insurance coverage, adequacy of health insurance coverage, public program participation, access to care, utilization of health care services, care coordination, satisfaction with care, and the impact of the special need on the family. Data collection began in October 2000 and will continue through March 2002. Summary reports and electronic data files will be available to the public within 6 to 12 months following completion of data collection. CONCLUSIONS: The National Survey of CSHCN will offer a unique data source for individuals and organizations interested in understanding and improving service delivery for CSHCN. It is an accomplishment that reflects the contributions of state and federal Title V programs, family organizations, provider organizations, health services researchers, and the broader maternal and child health community.

Adolescent↗

Medical image informatics infrastructure design and applications.

Picture archiving and communication systems (PACS) is a system integration of multimodality images and health information systems designed for improving the operation of a radiology department. As it evolves, PACS becomes a hospital image document management system with a voluminous image and related data file repository. A medical image informatics infrastructure can be designed to take advantage of existing data, providing PACS with add-on value for health care service, research, and education. A medical image informatics infrastructure (MIII) consists of the following components: medical images and associated data (including PACS database), image processing, data/knowledge base management, visualization, graphic user interface, communication networking, and application oriented software. This paper describes these components and their logical connection, and illustrates some applications based on the concept of the MIII.

Age Determination by Skeleton↗

Determinants of total family charges for health care: United States, 1980.

This report addresses a question of importance for policymakers: "What are the determinants of the total charges for health care that U.S. families face?" Policymakers' concerns about this question have two main grounds. First, U.S. health care costs are large and growing rapidly. They now exceed 11 percent of the gross national product, and the answer to the question can shed some light on their troubling growth. Second, total family charges for health care reflect the quantity of health care received by families, and it is important to know whether the determinants of total charges are principally the need for health care, or involve other factors less related to need. In this report, the determinants of total charges and their importance are identified principally through multiple regression analysis. Total charges are defined as the full amount charged for all types of health care for all family members regardless of whether these amounts are paid out of pocket, paid by insurance (or public health care coverage programs), or go unpaid. The data used are from the family data files of the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES). This report presents data on the approximately 5,000 multiple-person families interviewed in this year-long longitudinal survey. The report provides a separate analysis for each of three socioeconomic family populations that have consistently been of interest to policymakers. These are (1) older families (defined for this report as all U.S. multiple-person families with a member 65 years of age or over); (2) younger, lower income families (all U.S. multiple-person families below 200 percent of the poverty level in 1980 and with all members under 65 years of age); and (3) younger, better off families (all U.S. multiple-person families at 200 percent of the poverty level or higher in 1980 and with all members under 65). Multiple regression analysis was used to investigate the effect on total family charges of family demographic and sociocultural characteristics, family illnesses, special health events (such as births, deaths, and hospitalizations of family members), general family health status, family income, family health insurance characteristics, and family geographic and urbanization characteristics. Regressions were run separately for each of the three socio-economic family populations, with total family charges as the dependent variable and approximately 45 variables measuring these family characteristics as independent variables. Because of the large number of independent variables involved, a multiple-step regression process (described in appendix I) was used.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗