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Using statistical process control to make data-based clinical decisions.

Applied behavior analysis is based on an investigation of variability due to interrelationships among antecedents, behavior, and consequences. This permits testable hypotheses about the causes of behavior as well as for the course of treatment to be evaluated empirically. Such information provides corrective feedback for making data-based clinical decisions. This paper considers how a different approach to the analysis of variability based on the writings of Walter Shewart and W. Edwards Deming in the area of industrial quality control helps to achieve similar objectives. Statistical process control (SPC) was developed to implement a process of continual product improvement while achieving compliance with production standards and other requirements for promoting customer satisfaction. SPC involves the use of simple statistical tools, such as histograms and control charts, as well as problem-solving techniques, such as flow charts, cause-and-effect diagrams, and Pareto charts, to implement Deming's management philosophy. These data-analytic procedures can be incorporated into a human service organization to help to achieve its stated objectives in a manner that leads to continuous improvement in the functioning of the clients who are its customers. Examples are provided to illustrate how SPC procedures can be used to analyze behavioral data. Issues related to the application of these tools for making data-based clinical decisions and for creating an organizational climate that promotes their routine use in applied settings are also considered.

Adult↗

Analysis of epidemiologic case-base studies for binary data.

Recent developments in statistical methods for epidemiology have revived the application of sampling techniques in the design and analysis of cohort studies. The 'case-base' design involves sampling of both the cases and the cohort base of the study. This paper reviews some data-analytic imperfections of the approaches to risk ratio estimation, and modifies and advances a consistent likelihood-based procedure-analogous to Miettinen and Nurminen's proposal for a full cohort design--for interval estimation (and also point estimation and significance testing) in the context of binary case-base data. First, the procedure avoids the use of Taylor-series approximations to derive variance estimators for non-linear functions of parameters. Second, the asymptotic condition effects a simple computational expression for the chi-square function of risk ratios that is universally applicable to small samples. The statistical modelling underlying the method allows inferences about risk ratios without the assumption of rare disease either for the general population or for a particular base. The paper also extends the analysis to encompass stratified data. Finally, a numerical evaluation evinced the accurate small-sample properties of the proposed method.

Binomial Distribution↗

Biological SOAP servers and web services provided by the public sequence data bank.

A number of biological data resources (i.e. databases and data analytical tools) are searchable and usable on-line thanks to the internet and the World Wide Web (WWW) servers. The output from the web server is easy for us to browse. However, it is laborious and sometimes impossible for us to write a computer program that finds a useful data resource, sends a proper query and processes the output. It is a serious obstacle to the integration of distributed heterogeneous data resources. To solve the issue, we have implemented a SOAP (Simple Object Access Protocol) server and web services that provide a program-friendly interface. The web services are accessible at http://www.xml.nig.ac.jp/.

Databases, Nucleic Acid↗

Biological indicators of chrysotile exposure.

Chrysotile asbestos is retained in lung tissue, where it may be used as a marker of exposure. Studies include analysis of sputum and bronchoalveolar lavage fluid, but principally lung parenchyma from autopsy or surgically resected specimens. Asbestos bodies form on chrysotile fibres but are generally not a good indicator of human exposure to chrysotile because of their greater probability of formation on amphiboles. Chrysotile fibre analyses in lung have advantages and limitations. Chrysotile concentration is related to the level of environmental and occupational exposure, but in the latter situation owing to deposition, fibre alteration and clearance cumulative exposure and interval between end-exposure and death clearly affect results. Autopsy case series are biased toward increased proportions of asbestos-related diseases as compared to epidemiological cohort data. Analytical problems include potential contamination by chrysotile at autopsy, from fixatives, from post-fixative processing and in the analytical laboratory itself. These may have greatest effect in studies of individuals with low exposure, for tissue other than lung, and for short chrysotile fibres. Selection of control subjects should be contemporaneous with that of cases, and control subjects should fully reflect the hospital population at the time of case death. Limited data are available on fibre analysis in pleural tissue. More are needed. Issues requiring attention include avoidance of contamination, selection of controls, and sample site selection (parietal pleura, or tumour or plaque). For mesothelioma, two case-control studies of lung fibre burden show the principal relationship to be with long amphiboles, but some methodological problems exist. Lung cancer shows no such fibre-type differences. Asbestosis seems to be associated with long-fibre chrysotile and tremolite in one study and short fibres in others. Overall, lung retained dose is a useful indicator of chrysotile exposure if used cautiously in inference, and is very useful in the evaluation of historical exposures and industrial hygiene data in epidemiological studies.

Asbestos, Serpentine↗

[Genotoxicity of stack gas condensates of Bavarian waste incineration plants. IV. Overview and short comments on the results].

Emissions from waste incineration plants can be monitored relatively simply and cost-effectively via stack gas condensates. We compared quantitative chemical-analytic data of stack gases with two genotoxicity tests. The tests employed, i.e. a new, simple UDS assay variant with the human lung cell lines NCI-H 322 and 358, developed for this purpose, and an automated version of the SOS chromotest, were validated with respect to the contents of stack gases analytically detected. As judged by Bavarian waste incineration plants, sampled in the years 1990 to 1995, we obtained the following principle results: A drastic reduction of the genotoxicity from stack gases in the sampling period was observed with both tests. There were found genotoxic stack gases with the more sensitive UDS assay also in modern plants at the end of sampling period. Up to 99% of the organic components were not detected by chemical analysis despite an extensive program of analytics. The concentration of the quantified cancerogenic organic single substances from the samples did not suffice to explain genotoxic effects in the stack gases. Unknown, not identified stack gas contents are mainly responsible for the genotoxic potential of the stack gases. According to our results, emissions of modern waste incineration plants are likely to increase the genotoxic hazardous potential of the air only insignificantly even in pollution-free zones.

Air Pollutants↗

Food groups as the source of retinoids, carotenoids, and vitamin A in Finland.

The average retinoid, carotenoid, and vitamin A (RE, retinol equivalents) intake of the Finnish population was determined. The food consumption data were derived mainly from the national food balance sheets (for 1987). In this study, the average Finnish diet was composed twice a year, and the retinoid and carotenoid composition was analysed using high-performance liquid chromatography (HPLC). The intake of retinoids and carotenoids was also calculated using the most recent Finnish analytical data on food composition. The vitamin A content of beef, chicken and pork liver, all of which contribute of the vitamin A intake, at different times of the year was determined. The beta-carotene intake in Finland varied between 1700 and 2100 micrograms/day, depending on the season. It is obvious that liver consumption plays a significant role in the vitamin A intake. Since the concentration of retinoids in liver, and especially in pork liver, is extremely high, the average vitamin A intake of the Finnish population may exceed 3000 RE/day. If liver consumption (3.7 g/day) is excluded, the average daily vitamin A intake in Finland is 970-1200 RE, a value in better agreement with the recommended daily allowances.

Animals↗

[Problems related to trace element determination in biological materials].

Analytical problems related to the determination of ultratrace elements such as Cr, Cd, Co, Ni, V in biological materials are described. Prevention of contamination from analytical devices, reagents and the environment is a crucial factor to achieve ultratrace analysis; a stainless steel needle cannot be used for the Cr determination in human serum. Careful examination of the impurity in the labowares and reagents is definitely required prior to analysis. In graphite furnace atomic absorption spectrometry, appropriate background correction is most important to obtain accurate analytical data for biological materials. Appropriate selection of matrix modifier(s) can reduce background signals to a negligible level. In ICP mass spectrometry mass overlapping by polyatomic ions is a most serious problem for the determination of most essential trace elements. Biological certified reference materials (CRMs) are of great value to assess accuracy of analytical results. However, the availability of human serum reference materials representative of normal values has been limited. Development of such biological reference materials (human serum, urine) is urgently required for analytical quality assurance.

Humans↗

Analysis of data from the analytical ultracentrifuge by nonlinear least-squares techniques.

Least-squares analysis of experimental data from the analytical ultracentrifuge is discussed in detail, with particular attention to the use of interference optics in studying nonideal self-associating macromolecular systems. Several samples are given that describe the application of the technique, the expected precision of the results, and some of its limitations. A FORTRAN IV computer program is available from the authors.

Computers↗

Post-translational events in proteoglycan synthesis: kinetics of synthesis of chondroitin sulfate and oligosaccharides on the core protein.

Chondrocytes isolated from the Swarm rat chondrosarcoma were incubated in culture with [1-3H]glucose for 30 min to 8 h. Labeled proteoglycans were isolated, treated with borohydride under alkaline conditions, and the three complex sugar structures purified: N- and O-linked oligosaccharides and chondroitin sulfate chains. The amount of incorporated radioactivity into each component sugar was analyzed by HPLC after enzyme digestion and hydrolysis. The kinetic data for labeling of each sugar over the time course of the experiment were fit to first-order rate equations and the half times (t1/2) to linear labeling were calculated. The t1/2 values were essentially the same, 5-8 min, for galactose in all three complex sugar structures and for chain glucuronic acid in chondroitin sulfate, while that for xylitol in chondroitin sulfate, 15.8 min, was significantly longer. Thus, oligosaccharide synthesis is concomitant with chondroitin sulfate chain synthesis; the addition of the chondroitin sulfate linkage galactose occurs at or nearly at the same time as chain elongation while the addition of linkage xylose residues to the core protein may precede chain synthesis by up to 8 min. Since the intracellular t1/2 of the core protein precursor for these cells is 45 to 90 min, the data strongly suggest that the addition of xylose is not completed to any significant extent while the polypeptide is still nascent or shortly after its release into the rough endoplasmic reticulum. It is proposed that the addition of xylose to the core protein precursor is a late endoplasmic reticulum or early Golgi event. The analytical data were consistent with the presence of ester phosphate on about 80% of the xylose residues of the newly synthesized proteoglycan.

Aggrecans↗

Characterization of three rifamycins via electrospray mass spectrometry and HPLC-thermospray mass spectrometry.

Rifamycins are a class of antibiotic compounds of which rifampicin is the most commonly prescribed. Conventional electron-impact mass spectrometry of rifampicin has not been found to provide useful data. Thermospray and electrospray mass spectrometry are studied as potential tools for the analysis of rifampicin, rifamycin SV, and rifamycin B. Using thermospray and electrospray ionization, all three compounds provide significant ion intensity for either the [MH]+ or [MNa]+ ions. In addition, combined high-performance liquid chromatography-thermospray mass spectrometry provides useful analytical data for a mixture of the three rifamycins.

Chromatography, High Pressure Liquid↗

Anabolic steroids in sport: biochemical, clinical and analytical perspectives.

International Olympic Committee accredited laboratories play a key role in upholding the principle of fair play and innate ability, as desired by the majority of sports competitors and spectators. Not only does doping damage the image of sport, but it can also be harmful to the individual. The great majority of samples test negative but, when an adverse finding is declared, the analytical data must be of a sufficiently high standard to withstand legal challenges by third parties. The most widely misused performance-enhancing drugs are the anabolic-androgenic steroids, commonly referred to as 'anabolic steroids'. This review attempts to address the complex issues concerning anabolic steroids in sport by considering the clinical, biochemical and analytical perspectives.

Anabolic Agents↗

Applications of computer software for the interpretation and management of mass spectrometry data in pharmaceutical science.

The rapid growth of mass spectrometry (MS)-based computer software applications has been fueled by the unprecedented need to capture and analyze MS data and provide the information necessary for decision-making. Shorter timelines and a significantly greater number of samples has resulted in a tremendous focus on streamlined approaches that provide scientists, managers, and executives the capability to readily obtain, or even request, the necessary information that leads to accelerated product development. The generation of analytical data using roboticized high-throughput hardware has produced a bottleneck since data can be generated faster than it can be analyzed. New techniques including MS/MS and accurate mass experiments are feasible only using computers to capture and manage the enormous amounts of data necessary to perform the experiments. Whatever the nature of the experiments conducted, the MS analysis strategy is to extract the appropriate information required for decision-making in as facile a manner as possible. We will review here a survey of the creation of commercial and laboratory specific reference databases and associated searching algorithms and also recent efforts to introduce advancedprocessing and analysis algorithms to the hands of the masses, specifically as an aid to structure elucidation.

Chemistry, Pharmaceutical↗

Diagnostic value and incremental contribution of bicycle exercise, first-pass radionuclide angiography, and 99mTc-labeled sestamibi single-photon emission computed tomography in the identification of coronary artery disease in patients without infarction.

BACKGROUND: The diagnostic value and incremental contribution of different noninvasive tests to the identification of coronary artery disease in 128 patients from a general population with intermediate pretest likelihood (48.0%) were determined by ordered logistic regression analysis and receiver-operating characteristic (ROC) curves. METHODS AND RESULTS: Patients referred for suspicion of coronary heart disease were submitted to bicycle exercise testing under clinical and electrocardiographic control. AT peak exercise, first-pass radionuclide angiography was performed after injection of 99mTc-labeled sestamibi, followed by single-photon emission computed tomographic (SPECT) acquisition. A comparative rest study was obtained within 1 week, and qualitative and quantitative analysis was applied to assess the presence and extent of disease. With coronary angiography and 50% stenosis used as a standard, the discriminative accuracy of each test was calculated. The accuracies to diagnose coronary heart disease were 71.3% +/- 4.7% for the bicycle test, 66.7% +/- 5.3% for radionuclide angiography, and 81.6% +/- 3.9% for the SPECT data. By ROC curves, the optimal criteria for positivity were determined for the visual and quantitative analysis for both presence and extent of coronary artery disease. Results of visual and quantitative SPECT were compared in terms of area under the ROC curves. The diagnostic performances showed no significant difference, ranging from 74.3% to 81.6%. The first-pass radionuclide angiographic and SPECT data were added progressively to the stress testing to evaluate their incremental diagnostic contribution. Only the addition of SPECT results significantly increased the accuracy to 85.6% +/- 3.3% (p < 0.0001). CONCLUSION: Exercise electrocardiography and first-pass radionuclide angiography showed comparable accuracy to detect coronary artery disease. However, the combination of exercise testing and visual SPECT analytic data sufficed to ensure diagnostic accuracy, without significant benefit from the addition of other tests or the application of quantification.

Case-Control Studies↗

Phyto-oestrogen database of foods and average intake in Finland.

Information on phyto-oestrogen intake in various populations has been scanty until now, primarily because data on the content of these compounds in foods were lacking. We report here on expansion of the Finnish National Food Composition Database (Fineli) with values for the plant lignans matairesinol and secoisolariciresinol and the isoflavones daidzein and genistein. The values, expressed as aglycones, were based on food analyses (mainly GC-MS) or imputed from analytical data for 180 foods for lignans and 160 foods for isoflavones; additionally, over 1000 values were derived from the recipe database of Fineli. Average intake of these phyto-oestrogens was calculated using food consumption data of the National Dietary Survey FINDIET 1997, which was carried out in a random sample of the adult population in five areas in Finland. The dietary data were collected by 24 h recall =2862). The mean lignan intake was 434 (standard deviation (SD) 1575) microg/d and the mean isoflavone intake was 788 (SD 673) microg/d. Women had a higher lignan density (microg lignans/MJ) in their diet than men (P<0.05). Men had a higher mean daily isoflavone intake, 902 (SD 368) microg, than women, 668 (SD 963) microg (P<0.05). The sources of lignans were many: seeds, cereals, fruit, berries and vegetables. The main sources of isoflavones appeared to be processed meat products/sausages containing soya as an ingredient, and legumes as such. The average intake of lignans and isoflavones in Finland seems to be low, but intake varies throughout the population.

Adult↗

Design of sampling plans for mycotoxins in foods and feeds.

The control of the occurrence of mycotoxins in foods and feeds requires effective surveillance and quality control procedures which facilitate the identification and control of the mycotoxin problem respectively. Surveillance and quality control procedures involve a sequence of sampling, sample preparation, and analysis steps; and the integrity of the data produced by these procedures will be determined by the effectiveness of these steps. It is imperative that the sampling step is performed as accurately as possible so that the sample collected is representative of the batch of food or feed under investigation. Needless to say, the collection of a biased sample will completely invalidate the resultant analytical data. Most attempts to develop effective sampling protocols have focused upon the aflatoxins, since the majority of current regulations are concerned specifically with this group of mycotoxins. However, the design of effective sampling protocols has been severely hindered by the highly skewed distribution of the aflatoxins in foods and feeds. Studies already performed indicate that representative samples of commodities, composed of large particles (e.g., corn and oilseed kernels) should be 10 kg in weight, at least, and composed of approximately one hundred incremental samples. Similar studies have indicated that samples of oilseed cakes and meal, however, should be composed of fifty incremental samples which afford a composite sample of approximately 5 kg in weight.

Food Analysis↗

Structure and composition of the septal nacreous layer of Nautilus macromphalus L. (Mollusca, Cephalopoda).

The nacreous layer of Mollusca is the best-known aragonitic structure and is the usual model for biomineralization. However, data are based on less than 10 species. In situ observations of the septal nacreous layer of the cephalopod Nautilus shell has revealed that the tablets are composed of acicular laths. These laths are composed of round nanograins surrounded by an organic sheet. No hole has been observed in the decalcified interlamellar membranes. A set of combined analytical data shows that the organic matrices extracted from the nacreous layer are glycoproteins. In both soluble and insoluble matrices, S amino acids are rare and the soluble organic matrices have a higher sulfated sugar content than the insoluble matrices. It is possible that the observed differences in the structure and composition of the nacreous layers of the outer wall and septa of the Nautilus shell have a dual origin: evolution and functional adaptation. However, we have no appropriate data as yet to answer this question.

Animals↗

Time-weighted average sampling of volatile and semi-volatile airborne organic compounds by the solid-phase microextraction device.

The ultimate goal of the chemist is to perform sample preparation, and analysis, if possible at the place where a sample is located rather than moving the sample to laboratory, as is common practice in many cases at the present time. This approach eliminates errors and time associated with sample transport and storage and therefore it would result in more accurate, precise and faster analytical data. In addition to portability, two other important features of ideal field sample preparation technique are elimination of solvent use and integration with a sampling step. A method is developed which addresses these requirements for the determination of time-weighted average concentration of gas phase compounds using a solid-phase microextraction device. Quantification of target analytes in air using this method can be carried out without external calibration. The volatile and semi-volatile organic compounds in air diffuse into the fiber coating which is retracted a known distance into its needle housing during the sampling period. The coatings used are poly(dimethylsiloxane) and poly(dimethylsiloxane)-divinylbenzene. The sampling rate at which gas phase analytes load onto the fiber is determined for a wide range of hydrocarbons. There is a good agreement between the theoretical and experimental sampling rates. Sampling time ranges from 1 min to 24 h depending on the coating used and its retraction distance. Effect of the flow-rate on the uptake rate by the fiber is studied. The method is tested in the field and compared with National Institute of Occupational Health and Safety Method 1550. Good agreement between the results is obtained.

Chromatography↗

Measuring youth outcomes from alcohol and drug treatment.

AIMS: This report examines adolescent alcohol and drug treatment outcome research from a process-oriented, developmental perspective. A dynamic developmental model is proposed in which adolescent treatment outcome research incorporate considerations relevant to changes occurring typically during this stage of life as well as developmental distinctions pertinent to the early onset of abuse and dependence. METHOD: Findings from our developmentally focused longitudinal research of adolescent treatment participants and the extant literature on adolescent treatment outcome are reviewed. Conceptual, research design and measurement recommendations are presented from this double developmental perspective of addiction. FINDINGS: Techniques for engaging youth in the research process, managing confidentiality and facilitating self-disclosure are described. Developmental considerations in the type and timing of outcome assessments, measurement content, predictor domains and data analytical approaches are discussed. Predictors and process measures for adolescent alcohol treatment outcome study are suggested based on current findings. CONCLUSIONS: Inclusion of developmental considerations may enhance the utility of adolescent treatment outcome research.

Adolescent↗