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At least 379 records · Page 21Linked to original sources
PubMed2002

Use of out-of-hospital variables to predict severity of injury in pediatric patients involved in motor vehicle crashes.

STUDY OBJECTIVE: We sought to create a clinical decision rule, on the basis of variables available to out-of-hospital personnel, that could be used to accurately predict severe injury in pediatric patients involved in motor vehicle crashes as occupants. METHODS: We analyzed the National Automotive Sampling System database, a national probability sample, using pediatric patients up to 15 years old (occupants only) involved in motor vehicle crashes from January 1993 to December 1999. The National Automotive Sampling System database includes patients from regions throughout the country, weighted to represent a nationwide sample. Twelve out-of-hospital variables were used in classification and regression tree analysis to create a decision rule separating children with severe injuries (Injury Severity Score [ISS] > or =16) from those with minor injuries (ISS < 16). Misclassification costs and complexity parameters were selected to yield a decision tree with appropriate sensitivity and specificity for the identification of severely injured patients, while also being simple and practical for out-of-hospital use. Probability weights were used throughout the analysis to account for the sampling design and sampling weights. RESULTS: Using a sample size of 8,392 children, we constructed a decision rule using 3 out-of-hospital variables (Glasgow Coma Scale score, passenger space intrusion > or =6 in [> or =15 cm], and restraint use) to predict those patients with an ISS of 16 or more. Internal cross-validation was used to determine the sensitivity and specificity, yielding values of 92% and 73%, respectively, for the prediction of patients with an ISS of 16 or more. CONCLUSION: Out-of-hospital variables available to field personnel could be used to effectively triage pediatric motor vehicle crash patients using the decision rule developed here. Prospective trials would be needed to test this decision rule in actual use.

Accidents, Traffic↗
PubMedDate not supplied

Self-reported physical activity, subjective health, and cognitive performance in older adults.

The literature to date suggests a positive relationship between physiological indicators of physical fitness (such as aerobic capacity) and indices of cognitive performance. However, the complexity and cost of methods to measure physical fitness prohibit their use in large-population studies in cognitive aging research. In this study, a questionnaire measuring habitual physical activity was used as an indirect estimate of physical fitness, to predict performance in several cognitive domains in an age- and sex-stratified sample of 80 healthy older adults (55 years and older). Age effects were found on several measures of cognitive speed and fluency, but not on memory performance. Women were slower in sensorimotor speed than men but scored higher on memory tasks. No main effects of activity on cognitive measures were found, but two measures that assessed cognitive speed were sensitive to the age-by-activity interaction term. Subjective health also appeared to contribute to the explained variance in the same two indices of cognitive speed. Limitations of the use of activity questionnaires in cognitive aging research are discussed.

Aged↗
PubMed2003

A passive flux denuder for evaluating emissions of ammonia at a dairy farm.

Passive samplers have been shown to be an inexpensive alternative to direct sampling. Diffusion denuders have been developed to measure the concentration of species such as ammonia (NH3), which is in equilibrium with particulate ammonium nitrate. Conventional denuder sampling has required active sampling that inherently requires air pumps and, therefore, electrical power. To estimate emissions of NH3 from a fugitive source would require an array of active samplers and meteorological measurements to estimate the flux. A recently developed fabric denuder was configured in an open tube to passively sample NH3 flux. Passive and active samplers were collocated at a dairy farm at the California State University, Fresno, Agricultural Research Facility. During this comparison study, NH3 flux measurements were made at the dairy farm lagoon before and after the lagoon underwent acidification. Comparisons were made of the flux measurements obtained directly from the passive flux denuder and those calculated from an active filter pack sampler and wind velocity. The results show significant correlation between the two methods, although a correction factor needed to be applied to directly compare the two techniques. This passive sampling approach significantly reduces the cost and complexity of sampling and has the potential to economically develop a larger inventory base for ambient NH3 emissions.

Air Pollutants↗
PubMed2005

Rethinking the place of the psyche in health: toward the integration of health care systems.

OBJECTIVE: To review the value provided when health care systems independently manage medical and psychiatric care. METHOD: The authors draw on data from the world literature, their own experiences and reflections (one author as an international consultant in the coordination of physical and behavioural health care), and input from colleagues throughout the world who face similar challenges to improve outcomes for complex, high cost patients in their own health care systems. RESULTS: Most health care systems in the world approach the administration and delivery of mental health care separately from that of general medical care. This practice is no longer supported as effective, efficient or inexpensive. Rather accumulating data indicates that concurrent and coordinated medical and psychiatric care, which can only be accomplished by integrating physical and behavioural health through infrastructure change, should replace the present system of independently provided sequential care; that is, one which provides first medical and then psychiatric treatment, or vice versa, with little communication between clinicians in the two sectors. CONCLUSIONS: By making mental health treatment an integral part of general medical care through reorganization of the funding system, a higher percentage of those now untreated for their psychiatric disorders, both within and outside of the medical setting, can have their mental health needs addressed in coordination with their physical disorders. At the same time, the number of patients that can be treated within the same budget will be expanded.

Australia↗
PubMed2004

Performance of magnesium ammonium phosphate precipitation and its effect on biological treatability of leather tanning industry wastewaters.

Leather tanning industry is one of the several industries discharging significant amount of nitrogen. Magnesium ammonium phosphate (MAP) precipitation is a promising pretreatment for leather tanning industry wastewaters for the control of toxic parameters; excess suspended solids as well as nitrogen which increase the cost and complexity of following biological treatment. Application of MAP precipitation, however, modifies the characteristics and biological treatability of wastewaters. In this study, characteristics and biological treatability of MAP precipitation effluent were experimentally investigated using the wastewaters obtained from a bovine leather processing plant. An experimental study involving the determination of COD fractions and kinetic parameters of biological treatment was conducted for both gravity settling and MAP precipitation. Results of the study indicated that MAP precipitation, in addition to high degree of nitrogen removal, yielded a soluble, readily biodegradable effluent which was also free from toxics. MAP precipitation provided an effluent COD of almost half of that of gravity settling. Reduced value of soluble residual microbial products (Sp) obtained with MAP precipitation effluent was an additional benefit.

Animals↗
PubMed2005

The World Health Organization/International Union Against Tuberculosis and Lung Disease Global Project on Surveillance for Anti-Tuberculosis Drug Resistance: a model for other infectious diseases.

Tuberculosis remains a global epidemic, with one-third of the population infected and 9 million active cases. Mono- and multidrug resistance in 6 World Health Organization (WHO) regions have been assessed in 40% of the global cases diagnosed by positive results of sputum testing. The 2004 report of the WHO Global Project on Anti-Tuberculosis Drug Resistance Surveillance confirms earlier findings that drug-resistant tuberculosis is ubiquitous and that multidrug-resistant tuberculosis has increased alarmingly. Control of tuberculosis, which is undermined by the human immunodeficiency virus (HIV) epidemic, is seriously jeopardized by multidrug resistant strains, for which treatment is complex, more costly, and less successful. Challenges for high-burden countries include implementation of the DOTS strategy and management of identified multidrug resistance with DOTS-Plus. Strengthening of the laboratory network in conjunction with improvement of surveillance, elucidation of the impact of HIV on transmission of tuberculosis and on amplification of resistance at individual and population levels, and implementation of private sector policies on drug resistance are imperative. New diagnostic tools and drugs are needed to expedite early detection and cure of multiresistant strains.

Drug Resistance, Bacterial↗
PubMed2002

Sleep studies for sleep apnoea.

Sleep studies have grown to encompass a broad range of technologies employed to study and diagnose a variety of sleep disorders. From their inception in neurophysiology laboratories interested in investigating primary disorders of sleep architecture from psychiatric illness, their remit has widened such that their most common role is currently to diagnose secondary sleep disruption from respiratory, cardiovascular or other systemic causes. This review outlines the pathophysiology of obstructive sleep apnoea in particular and how sleep studies have improved our understanding of the complex dynamic changes in blood gas tensions, cardiovascular control and cerebral arousal that occur with these repetitive events. We review the historical development of standard laboratory-based sleep studies and discuss their limitations in staging sleep, reflecting the episodes of increased upper airway resistance that underlie these disorders and their ability to predict individuals' symptoms or response to medical or surgical therapies. We then describe some alternative signals that have been employed to monitor the physiological changes in upper airway resistance and arousal with a discussion of some of the evidence that these 'limited' studies may provide diagnostic information that can guide clinical decision making and may predict the outcome without the need, in some cases, for more complex and costly laboratory-based studies.

Humans↗
PubMed2005

Oral gene therapy: a novel method for the manufacture and delivery of protein drugs.

Despite the great promise of a broadly based protein pharmaceutics, the use of protein drugs remains limited by drug availability due to the complexity and cost of manufacture, and patient compliance because of the need for needle injection. In this article we present proof of principle for a concept that avoids these difficulties and offers the prospect of greatly expanding the use and utility of protein drugs. Rather than the protein itself, the drug is a DNA plasmid that codes for it, that is swallowed, not injected. The protein is manufactured by the body in cells of the small intestine and is delivered by them into the bloodstream. The drug has a short-lived action and like other oral medications must be taken frequently (every day or two) to be effective. The short term of action is an advantage that provides for safe, easily managed treatment, unlike most gene-based therapies in use today. The dose of the drug can be altered from day to day, and treatment can be stopped quickly if untoward side effects are observed.

Administration, Oral↗
PubMed1990

Body composition of humans: comparison of two improved four-compartment models that differ in expense, technical complexity, and radiation exposure.

Multicompartment models are of growing importance in the study of body composition in humans. This study compares two improved four-compartment (water, protein, mineral, and fat) models that differ in expense, technological complexity, and radiation exposure. Primary data (from 31 subjects) for the first model were derived by dual-photon absorptiometry, 3H2O dilution, and hydrodensitometry and for the second model by delayed and prompt gamma neutron-activation analysis and 3H2O dilution. Estimates of fat, protein, and mineral from the first model were highly correlated with those from the second model (r = 0.98, 0.72, and 0.94, respectively; all p less than 0.001). The proportions of body weight represented by water, protein, mineral, and fat for the simpler first model (0.532, 0.155, 0.048, and 0.265) were similar to compartment fractions provided by the more complex and costly second model (0.532, 0.143, 0.046, and 0.279). Multicompartment body composition models can thus be developed from increasingly available techniques that compare favorably with similar results derived from limited-access instrumentation.

Absorptiometry, Photon↗
PubMed1996

Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee.

The World Health Organization (WHO) convened an Expert Committee to reevaluate the use of anthropometry at different ages for assessing health, nutrition, and social wellbeing. The Committee's task included identifying reference data for anthropometric indexes when appropriate, and providing guidelines on how the data should be used. For fetal growth, the Committee recommended an existing sex-specific multiracial reference. In view of the significant technical drawbacks of the current National Center for Health Statistics (NCHS)/WHO reference and its inadequacy for assessing the growth of breast-fed infants, the Committee recommended the development of a new reference concerning weight and length/height for infants and children, which will be a complex and costly undertaking. Proper interpretation of midupper arm circumference for preschoolers requires age-specific reference data. To evaluate adolescent height-for-age, the Committee recommended the current NCHS/WHO reference. Use of the NCHS body mass index (BMI) data, with their upper percentile elevations and skewness, is undesirable for setting health goals; however, these data were provisionally recommended for defining obesity based on a combination of elevated BMI and high subcutaneous fat. The NCHS values were provisionally recommended as reference data for subscapular and triceps skinfold thicknesses. Guidelines were also provided for adjusting adolescent anthropometric comparisons for maturational status. Currently, there is no need for adult reference data for BMI; interpretation should be based on pragmatic BMI cutoffs. Finally, the Committee noted that few normative anthropometric data exist for the elderly, especially for those > 80 y of age. Proper definitions of health status, function, and biologic age remain to be developed for this group.

Adolescent↗
PubMed1979

Manual and computerized cumulative reporting systems for the clinical microbiology laboratory.

A manual and a computerized system that produce cumulative updated reports from the clinical microbiology laboratory are described. Each system gives the physician a report that is clearly formatted, cumulative, readily updated, and written in conversational terms with minimal abbreviations. The report formats and updating sequences are nearly identical, so that one system can easily replace or back up the other. The cost and complexity of the hardware and software for the computerized system are modest, so that these are suitable for the moderate-sized hospital laboratory processing fewer than 10,000 specimens per year. Also, the laboratory personnel in our community-based nonteaching hospital were able to develop, set up, and support these systems without external consultation or purchased services. Therefore, the improved quality of reporting based on these types of systems can now be available to all laboratories without regard to size or workload.

Computers↗
PubMed2026

SIVA: diagonal integration of spatial multi-omics data via spatially informed variational autoencoders and anchor guidance.

MOTIVATION: Understanding cellular states and regulatory programs requires integrative analysis of multiple omics layers. Although recent spatial sequencing technologies allow molecular profiling of cells within their tissue context, paired spatial multi-omics assays are still limited by technical complexity and cost. This creates a pressing need for diagonal integration methods that enable joint analysis of unpaired spatial omics datasets. RESULTS: We propose SIVA, a deep generative framework based on Spatially-Informed Variational Autoencoders with Anchor Guidance, for diagonal integration of spatial multi-modal data. SIVA employs modality-specific variational autoencoders (VAEs) with a hybrid latent embedding that integrates Gaussian process and standard Gaussian priors, enabling joint modeling of spatially structured variation and dominant underlying data distributions across modalities. To facilitate cross-modal alignment in the absence of one-to-one cell correspondence, SIVA adopts a dual integration strategy combining global distribution alignment via Maximum Mean Discrepancy and local correspondence guidance using mutual nearest neighbor anchors. Extensive experiments across multiple cross-slice integration scenarios demonstrate that SIVA achieves robust and accurate integration of unpaired spatial omics datasets, consistently outperforming existing methods. AVAILABILITY AND IMPLEMENTATION: The source codes are available at https://github.com/PelenJiang/SIVA.

Autoencoder↗
PubMed2001

Prospect of a prophylactic vaccine for HIV.

Human immunodeficiency virus (HIV) continues to infect about 15,000 people every day, 90% of whom live in non-industrialised countries. So far, education programmes have only managed to slow, but not cease, the HIV spread, while powerful drug combinations are too costly and complex for the majority of HIV-infected people and in any case fail to clear HIV from the body. Under these circumstances, the best hope for controlling the HIV pandemic is the development of an effective prophylactic vaccine. With a series of new technologies and increased political and financial commitments, a growing momentum in the field of HIV-vaccine development promises exciting years ahead.

AIDS Vaccines↗
PubMed2003

Safe motherhood: a brief history of the global movement 1947-2002.

The health of mothers has long been acknowledged to be a cornerstone of public health and attention to unacceptably high level of maternal mortality has been a feature of global health and development discussions since the 1980s. However, although a few countries have made remarkable progress in recent years, the reality has not generally followed the rhetoric. Health and development partners have failed to invest seriously in safe motherhood and examples of large-scale and sustained programmes are rare. Safe motherhood has tended to be seen as a subset of other programmes such as child survival or reproductive health and is often perceived to be too complex or costly for under-resourced and overstretched health care systems that have limited capacity. Despite this, a consensus has emerged about the interventions needed to reduce maternal mortality and there are good examples (historical and contemporary) of what can be achieved within a relatively short time period. The activities of both grassroots organizations and international health and development agencies have helped to build political will and momentum. Further progress in improving maternal health will require outspoken and determined champions from within the health system and the medical community, particularly the obstetricians and gynaecologists, and from among decision-makers and politicians. But in addition, substantial and long-term funding--by governments and by donor agencies--is an essential and still missing component.

Female↗
PubMed2005

Patients, mean age 70 years, with automatic implantable cardioverter-defibrillators treated with dual-chamber rate responsive pacing (DDDR-70) have a higher mortality than patients with backup ventricular pacing (VVI-40) at 3.7-year follow-up.

BACKGROUND: One study showed in 506 patients with automatic implantable cardioverter-defibrillators (AICDs) that the mortality at 1-year follow-up was 6.5% with ventricular backup pacing at 40/minute (VVI-40) versus 10.1% in patients with dual-chamber rate responsive pacing at 70/minute (DDDR-70). METHODS: We performed a retrospective study to determine all-cause mortality in all patients at a university hospital who had AICDs without indications for antibradycardia pacing. Of 535 patients, mean age 70 +/- 12 years, 271 patients had backup ventricular pacing with a VVI-40, and 264 patients had dual-chamber rate responsive pacing with a DDDR-70. RESULTS: At 3.7-year mean follow-up, all-cause mortality was 19% (50 of 264 patients) in patients with DDDR-70 pacing versus 11% (29 of 271 patients) with VVI-40 pacing (p < .01). CONCLUSION: Because of the increased mortality, increased cost, and complexity for dual-chamber rate responsive pacing in patients with AICDs, concomitant DDDR pacing at a rate of 70/minute in patients without an indication for antibradycardia pacing is not warranted.

Age Factors↗
PubMed2004

An HIV prevalence-based model for estimating urban risk populations of injection drug users and men who have sex with men.

Issues of cost and complexity have limited the study of the population sizes of men who have sex with men (MSM) and injection drug users (IDUs), two groups at clearly increased risk for human immunodeficiency virus (HIV) and other acute and chronic diseases. We developed a prototypical, easily applied estimation model for these populations and applied it to Miami, Florida. This model combined HIV prevalence estimates, HIV seroprevalence rates, and census data to make plausible estimates of the number and proportion of MSM and IDUs under a number of assumptions. Sensitivity analyses were conducted to test the robustness of the model. The model suggests that approximately 9.5% (plausible range 7.7%-11.3%) of Miami males aged 18 years or older are MSM (point estimate, N = 76,500), and 1.4% (plausible range 0.9%-1.9%) of the total population aged 18 years or older are IDUs (point estimate, N = 23,700). Males may be about 2.5 times more likely than females to be IDUs. The estimates were reasonably robust to biases. The model was used to develop MSM and IDU population estimates in selected urban areas across Florida and should be replicable in other medium-to-large urban areas. Such estimates could be useful for behavioral surveillance and resource allocation, including enhanced targeting of community-based interventions for primary and secondary HIV prevention.

Adult↗
PubMed1985

Self-reported physical activity compared with maximal oxygen uptake.

Maximal oxygen uptake has been used as a measure of physical fitness. This measure increases by approximately 25% when sedentary individuals become more physically active. Oxygen uptake measurement in the laboratory or estimation in fieldwork is complex and costly with finite risk. For the present study, 36 men and 32 women completed the Paffenbarger Physical Activity Index Questionnaire, including a sweat-inducing physical activity frequency question, and had measurement of oxygen uptake during pedal ergometry. Using maximal oxygen uptake as the measure of fitness, the authors found that the Paffenbarger Physical Activity Index, although more detailed, may be less valid than the simpler sweat induction frequency question for estimating fitness. The correlations observed between the sweat question and oxygen uptake were 0.54 for males, 0.26 for females, and 0.46 for the total group. The correlations between the Physical Activity Index and oxygen uptake were 0.26 for males, 0.08 for females, and 0.29 for the total group. The regression relationship (oxygen uptake = 1.92 X (sweat days) + 23.76; standard error of estimate = 8.63 ml/kg/min) is significant for sweat versus oxygen uptake. While the confidence interval limits the practical ability to predict individual values, low cost, absence of risk, and population validity suggest that fitness can be assessed rapidly and simply for epidemiologic studies with a simple "sweat" question.

Adult↗
PubMed1996

Estimated gain in life expectancy. A simple tool to select optimal reperfusion treatment in individual patients with evolving myocardial infarction.

Currently several modes of reperfusion therapy for acute myocardial infarction are available. Streptokinase, accelerated alteplase and direct angioplasty are the most frequently used. These options are increasingly effective, but are also increasingly complex and costly. Since, unfortunately, physicians are often restricted by budget limitations, choices must be made in clinical practice to provide optimal therapy to individual patients. In order to guide such decision making, we developed a model to predict the expected benefit of therapy in terms of gain in life expectancy. Patients' life expectancy will decrease after infarction. Part of this loss can be prevented by early reperfusion therapy. The clinical benefit of therapy ranges from negligible gain in patients with small infarcts treated relatively late to an expected gain of more than 2 years in patients with extensive infarction treated within 3 h of onset of symptoms. The expected benefits are presented in a set of tables and depend on age, previous infarction, estimated infarct size, treatment delay and intracranial bleeding risk. With the help of these table, resources will be allocated in such a manner that patients who will benefit the most will receive the most effective therapy. Patients with similar expected treatment benefit will be offered the same mode of therapy. Future life years were discounted at 5% per year. The arbitrary thresholds currently applied for decision making at the Thoraxcenter are: no reperfusion therapy when the estimated gain in discounted life expectancy was < 1 month, streptokinase for 1-4 months and accelerated alteplase for a gain > or = 5 months. Direct angioplasty is recommended in patients with an estimated gain > or = 12 months, and in patients with an increased risk of intracranial bleeding. In this way, approximately 80% of our patients will be treated with thrombolytics (40% streptokinase and 40% accelerated alteplase), while in 10% direct angioplasty will be initiated. Patients with small infarcts presenting late will not receive reperfusion therapy. These threshold values have been chosen arbitrarily, and different thresholds may be selected in other centres. However, the developed model would guarantee that treatment decisions are made in a consistent manner, to provide optimal therapy for patients with evolving myocardial infarction, in spite of limited resources.

Adolescent↗