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Harmful events in crashes.

This study examined objects struck in motor vehicle crashes which cause injury or property damage--called harmful events on national accident data files. The percentage of loss due to fatalities was found to differ greatly by harmful event type. Comprehensive costs were used to combine data on fatalities, injuries, and property damage only (PDO) vehicles into a single economic measure of crash loss. Use of comprehensive costs can reduce distortions that may occur in analyses limited to fatal events. Large differences were identified in average injury costs by harmful event type, indicating the need to use specific harmful event injury costs in analyses whenever possible. Major differences found between first and most harmful events in ran-off-road crashes indicate a need for states to collect both data elements on their police accident report forms.

Accidents, Traffic↗

Data compression: 8-dimensional flow cytometric data processing with 28K addressable computer memory.

A method of data analysis for flow cytometry is presented which enables up to eight-dimensional data to be handled by a microcomputer with 28K addressable plus a further 32K non-addressable memory. The multi-parameter coordinates are coded into single numbers using a minimal modification of the array vector mapping equation. These code numbers, each of which corresponds to a given set of coordinates, and then ranked in ascending order according to magnitude and the frequency of each code number is found. Following this step the code is then decoded by integer arithmetic into its original coordinates which are then packed, together with the frequency, into two, three or four 16-bit words depending on the dimensionality of the data set. A five-dimensional data set is used as the illustration. Three regions were set on one two-dimensional data space and the five mono-dimensional histograms, plus a different bivariate distribution, were extracted in a single pass through the processed data file. In addition to considerable space saving the technique has two further attributes, namely, increased speed with which the user can appreciate multiparameter data and the ability to analyse such data sets with a microcomputer.

Algorithms↗

Quality science and quality assurance: observations of an environmental scientist.

The purpose of this manuscript is to examine the relationship between quality science (QS) and quality assurance (QA). Many research scientists definitely want to do QS, but are afraid or do not want to do QA because they are intimidated by the QA process or they do not appreciate the benefits of QA. Therefore, the relationship between QS and QA is examined in this manuscript by an environmental scientist who has conducted 30 years of research in university, contract and government laboratories. To start, QS is defined in this paper as data that are published in the peer-reviewed literature. The quality of the research data is assumed by the general scientific population to be directly proportional to the status of the journal. For example, it is highly prestigious to have an article published in Science. At the U.S. EPA, the procedure for sending a manuscript to a journal for publication is the responsibility of the senior author. The senior author of an EPA-sponsored manuscript is expected to have the manuscript reviewed by the coauthors (they should also review the data), then the manuscript must be reviewed by at least two other scientists, one of whom must be from outside the authors' division. After this review and approval by management, the manuscript is sent to a peer-reviewed journal, where it is reviewed by several anonymous scientists as determined by the journal. After the comments of the reviewers are addressed, the manuscript can either be accepted or rejected for publication by the journal. For the purpose of this manuscript, the definition of QA is defined as the guarantee from a review team that the entire study was adequately and correctly conducted and recorded according to the study protocol. Many scientists view QS and QA as separate entities. From the scientist's perspective, QA procedures are not applicable to research studies, and should be used only for studies that will be submitted to either the EPA or the FDA for regulatory approval (i.e., Good Laboratory Practice [GLP] studies). However, QA can be applied to both types of studies. A QA review will examine all aspects of the study including data files (notebooks, protocols), as well as equipment, sample storage, actual experimental organisms (animals or cells) and the management of all study records. The data from a QA-reviewed study are therefore more defensible in a court of law, and more reproducible due to more through, chronological records. Generally speaking, few coauthors of a scientific manuscript analyze the raw data in the laboratory notebooks or inspect the laboratory equipment. Furthermore, coauthors generally have not been in the laboratory where the research was conducted in order to observe quality control measures. These are the areas where a QA review is extremely beneficial. In summary, data in the peer-reviewed literature do not undergo the same type of review as do data that have undergone a QA review. QA reviews assist EPA scientists in conducting and improving their research studies by identifying both excellent study practices and study deficiencies to be addressed, which thereby produces higher quality scientific data. In the opinion of this EPA Scientist and QA Manager, although QA reviews do require effort from the scientist, data from research studies are strengthened by QA review when compared to data from peer-reviewed studies that have not undergone a QA review. QA reviews should be viewed as part of the entire research process--a part that improves the overall quality of the data.

Environmental Monitoring↗

Clinical Variant Interpretation with the Integrative Genomics Viewer (IGV) for Molecular Pathologists.

The integrative genomics viewer (IGV) is a pivotal tool in clinical genomics, enabling the visualization and interpretation of complex sequencing data. Bringing clinical knowledge to bear with visual evaluation of sequencing results is the primary means by which molecular pathologists and other professionals assess and finalize cases. A variety of software tools can assist, but their relationship to the underlying data must be understood and applied systematically. This study includes essential background on next-generation sequencing (NGS) data file types (e.g., FASTQ, BAM, VCF) with a discussion of their format and purpose. We then describe features of IGV that derive nuances from these files. We utilize a series of curated practical cases based on clinical vignettes through which the reader will interact with clinical NGS sequencing data using the IGV software to review various types of clinically relevant variants relative to the human reference genome. These clinical vignettes have been curated to describe examples of some of the complexities of interpretation of genomic data, and how utilizing IGV as part of a routine workflow can provide additional interpretive information for variants beyond routine bioinformatic software algorithm variant calls. The visual inspection of genomic variants utilizing the tools within IGV can unmask subtle contextual cues (i.e., variant allele frequency, strand bias, tissue-specific context) that can influence the interpretation of genomic variants. Although this study focuses on using IGV for the detection and interpretation of somatic variants, the provided applications can be extrapolated for use in the germline setting, including analysis of complex variants and detection of mosaicism.

Humans↗

Resource dependence and institutional elements in nursing home TQM adoption.

OBJECTIVE: To examine the contextual attributes that influence nursing home TQM adoption, as informed by resource dependence and institutional theories. DATA SOURCES: A survey of licensed nursing home administrators in the Commonwealth of Pennsylvania during 1994-1995, the Medicare and Medicaid Annual Certification Survey (MMACS) data file, and the Area Resource File (ARF). STUDY DESIGN: Because the dependent variable (TQM adoption vs. non-adoption) is dichotomous, the model was estimated using logistic regression. DATA COLLECTION: Of the 615 facilities that were mailed surveys, 241 (39.2%) returned completed questionnaires. No significant differences were observed between respondents and nonrespondents in size, for-profit status, system membership, registered nurse staffing, cited licensure deficiencies, Medicare census, or Medicaid census. PRINCIPAL FINDINGS: Perceived competition, Medicare's share of total hospital discharges in the market, and facility Medicare census were significant predictors of TQM adoption. CONCLUSIONS: Our results provide limited support for the association between some rational adaptive and institutional factors and TQM adoption in nursing homes. Perceived competition and the influence of the Medicare program both at the facility and the market level are associated with TQM adoption. However, other factors associated with TQM adoption in other industries, such as size, are not associated with TQM adoption in the nursing homes in this study.

Aged↗

Depression as a predictor for coronary heart disease. a review and meta-analysis.

OBJECTIVE: To review and quantify the impact of depression on the development of coronary heart disease (CHD) in initially healthy subjects. DATA SOURCES: Cohort studies on depression and CHD were searched in MEDLINE (1966-2000) and PSYCHINFO (1887-2000), bibliographies, expert consultation, and personal reference files. DATA SELECTION: Cohort studies with clinical depression or depressive mood as the exposure, and myocardial infarction or coronary death as the outcome. DATA EXTRACTION: Information on study design, sample size and characteristics, assessment of depression, outcome, number of cases, crude and most-adjusted relative risks, and variables used in multivariate adjustments were abstracted. DATA SYNTHESIS: Eleven studies met the inclusion criteria. The overall relative risk [RR] for the development of CHD in depressed subjects was 1.64 (95% confidence interval [CI]=1.29-2.08, p<0.001). A sensitivity analysis showed that clinical depression (RR=2.69, 95% CI=1.63-4.43, p<0.001) was a stronger predictor than depressive mood (RR=1.49, 95% CI=1.16-1.92, p=0.02). CONCLUSION: It is concluded that depression predicts the development of CHD in initially healthy people. The stronger effect size for clinical depression compared to depressive mood points out that there might be a dose-response relationship between depression and CHD. Implications of the findings for a broader bio-psycho-social framework are discussed.

Adolescent↗

Measurements and calculations of neutron spectra modified by iron slabs bombarded by neutrons with energies up to 14 MeV.

Neutron spectra behind iron slabs of different thicknesses have been measured in the energy range from 1.6 to 14 MeV using a proton recoil spectrometer and 2H(d, n)3He and 9Be(d, n)10B neutron sources. The measured results have been compared with the predicted ones using the three dimensional Monte Carlo code MCNP 4A and pointwise cross sections from the ENDF/B-IV and ENDF/B-VI data files. The results show that the ENDF/B-IV calculations are in better agreement with the experiment than those obtained by using the ENDF/B-VI cross section data.

Journal Article↗

Unstable inferences? An examination of complex survey sample design adjustments using the Current Population Survey for health services research.

Statistical analysis of the Current Population Survey's Annual Social and Economic Supplement is used widely in health services research. However, the statistical evidence cited from the Current Population Survey (CPS) is not always consistent because researchers use a variety of methods to produce standard errors that are fundamental to significance tests. This analysis examines the 2002 Annual Social and Economic Supplement's (ASEC) estimates of national and state average income, national and state poverty rates, and national and state health insurance coverage rates. Findings show that the standard error estimates derived from the public use CPS data perform poorly compared with the survey design-based estimates derived from restricted internal data, and that the generalized variance parameters currently used by the U.S. Census Bureau in its ASEC reports and funding formula inputs perform erratically. Because the majority of published research (both by academics and Census Bureau analysts) does not make use of the survey design-based information available only on the internal ASEC data file, we argue that the Census Bureau ought to use alternative methods for its official ASEC reports. We also argue that for public use data the Census Bureau should produce a set of replicate weights for the ASEC or release a set of sample design variables that incorporate statistical "noise" to maintain respondent confidentiality (e.g., pseudo-primary sampling units) as other federal government surveys do. This is essential to make appropriate inferences using the ASEC data regarding statistical significance and estimate variance for health policy analysis.

Censuses↗

Thyroxine suppressive therapy in patients with nodular thyroid disease.

PURPOSE: To review evidence about thyroxine suppressive therapy in patients with thyroid nodules, including the clinical importance and natural history of nodules and the effects and potential side effects of thyroxine therapy. DATA SOURCES: English-language articles published from 1986 to December 1996 were identified through searches of the MEDLINE database, selected bibliographies, and personal files. DATA EXTRACTION: Randomized, controlled trials and nonrandomized trials of thyroxine suppressive therapy for solitary and predominantly solid thyroid nodules were reviewed. In most studies, nodule cytology was evaluated by fine-needle aspiration biopsy. Therapy was considered suppressive if suppression was documented by thyroid-stimulating hormone-releasing hormone tests or sensitive thyroid-stimulating hormone assays. Response was defined as a decrease of 50% or more in nodule size or volume; most recent studies measured nodule size by ultrasonography. DATA SYNTHESIS: The evidence suggests that thyroxine suppressive therapy fails to shrink most nodules: Only 10% to 20% of nodules responded to this treatment. Fine-needle aspiration biopsy is more reliable in distinguishing benign from malignant nodules. Recent studies suggest that spontaneous decrease in size with complete disappearance of thyroid nodules is not uncommon. No data show that thyroxine therapy arrests further growth in most existing nodules or prevents the emergence of new nodules. Postoperative thyroxine therapy does not seem to prevent recurrence of thyroid nodules except in patients with a history of radiation therapy. Potential adverse effects of long-term suppressive therapy include osteoporosis and heart disease. CONCLUSIONS: Patients with cytologically benign nodules are best followed without thyroxine treatment. Most benign nodules remain stable in size and remain benign when monitored for a long time. For nodules that increase in size, biopsy should be done again or surgery should be performed.

Biopsy, Needle↗

Medical staff planning with a database.

Staff planning requires a comprehensive program. A robust impact analysis of physicians requires information not normally contained within hospital physician records. Planners should integrate information from state sources with their medical staff data files, and be alert for new sources of online information.

Adult↗

Government statistics: the conflict between research and privacy.

The production of social statistics has been challenged in certain West European nations by the "privacy issue." Privacy advocates contend that computerized data files containing information about individuals endanger personal privacy and other civil liberties. The privacy issue has taken two forms: anti-census campaigns and data protection systems. Although those responsible for statistical data have traditionally safeguarded their records, they are often drawn into this issue. Increasingly, they have had to deal with the sociopolitical environment through legislative liaisons, lawyers, and advertising agencies. They have also had to revise data collection and processing procedures. In some situations, they have had to suspend censuses and surveys.

Confidentiality↗

Computer software for testing drug susceptibility of malaria parasites.

A computer program is described for the automated analysis of data obtained by flow cytometry for in vitro antimalarial drug susceptibility testing. Samples of malaria-infected red blood cells (RBC), which were cultured in the presence of different concentrations of antimalarial drugs, were stained with Hoechst. The Hoechst fluorescence intensity of infected RBC corresponds to DNA content of the parasites and to their stage of development. After measurement of the samples by a FACStar flow cytometer equipped with a UV laser and an autosampler, FCS 1.0 data files were generated. The HP PAS-CAL program developed for these files identifies five different populations--uninfected RBC, infected RBC, free parasites, leukocytes, and debris--on the basis of their light scatter and fluorescence characteristics. The program calculates the percentage of infected cells, the total number of parasite nuclei, and the average number of nuclei per parasite. The results of each culture are presented as a drug dose-response curve. During data analysis, user interaction is limited to selecting the first file of the first culture. The algorithm then processes each culture automatically. Potential problems or difficulties in analysis are flagged. To date, a total of 862 drug tests have been evaluated and fall into two classes, an extended microtest and the World Health Organization standardized microtest. These tests gave satisfactory results in more than 99% of the cases.

Animals↗

A taxonomy for classification of stroke rehabilitation services.

OBJECTIVE: To develop a taxonomy for use in measuring stroke rehabilitation services. DESIGN: A cross-sectional study using facility-level survey data and extant data files. SETTING: Veterans Administration medical centers (VAMCs). VARIABLES: (1) A list of rehabilitation characteristics, including personnel, physical facilities, coordination of care, and hospital characteristics; and (2) a classification or typology of VAMCs according to the type of postacute stroke care on-site. MAIN OUTCOME MEASURES: Data sources included extant Veterans Administration (VA) computerized databases, VA central office administrative files, and 2 mailed surveys to VA rehabilitation medicine services and stroke acute care services. The rehabilitation taxonomy was derived using 2 methods that assess face and construct validity, respectively: (1) an expert panel rating, using a modified Delphi process, of the clinical importance of each of the rehabilitation characteristics; and (2) a comparison of rehabilitation characteristics across the different types of VAMCs. Variables were included in the final taxonomy if the expert panel reached consensus that the variable was clinically important, or if there were statistically significant differences in these characteristics across the different types of medical centers. RESULTS: Of 67 possible rehabilitation characteristics, a multidisciplinary expert panel reached consensus about the likely clinical importance of 21 rehabilitation characteristics, 11 of which showed statistically significant differences across different types of VAMCs. An additional 9 variables that lacked expert panel consensus differed significantly among the different medical centers. These 30 variables represent a preliminary taxonomy of key rehabilitation characteristics. Among the 20 variables that varied significantly across the different types of medical centers, 18 showed a pattern with the greatest amount of resources and organizational sophistication being found in VAMCs with rehabilitation units, followed by medical centers with geriatric units, and the least amount of resources and organizational sophistication was seen in medical centers whose postacute care services were limited to nursing home or intermediate care. CONCLUSION: Thirty rehabilitation characteristics had face validity and/or construct validity, and can be considered to represent a preliminary taxonomy for measuring stroke rehabilitation services. This study also shows that there are significant differences among hospitals in resources and organization of care deemed to be important for stroke patients.

Aged↗

Dual-mode computer processing for high resolution DNA thermal denaturation experiments.

Two modes of data processing are appropriate in conducting high resolution thermal denaturation experiments (thermal increments of 0.05 degrees or closer). In the first mode, a general purpose microcomputer provides on-line services important to the control and monitoring of the initial experiment, including control of the spectrophotometer and heater, the recording of data, and the display of current hyperchromicities and approximate first derivatives. A subsequent microcomputer program then reads the recorded data files and carries out accurate calculations of derivative denaturation profiles and the estimate of the statistical error of the first derivative at each point. The data collection program handles three samples at a time and was designed to provide optimal results in thermal denaturation experiments with a single-beam spectrophotometer.

Computers↗

Does chain affiliation make a difference in efficiency of dialysis providers in the USA.

There has been an accelerated movement in the USA dialysis market towards affiliation with chain organizations. But little is known about the impact of this strategy of consolidation on provider performance of efficiency. This paper examines whether affiliation with multi-center dialysis chains creates a difference in technical efficiency. Data were obtained from 1994 to 2000 Independent Renal Facility Cost Report Data files of the Centers for Medicare and Medicaid Studies. Using multiple time series design with a comparison group, technical efficiency was examined through an intertemporal data envelopment analysis. The results showed that mean efficiency scores of chain-affiliated facilities in both pre- and post-affiliation periods are slightly higher than those of their independent counterparts, but the difference was not statistically significant. Members of the first and second largest chains did not appear to gain benefit from affiliation. In conclusion, greater technical efficiency of affiliated facilities is not the result of system engagement but rather the result of organizational maturation, or organizational learning. Engagement with the two largest systems does not provide members with its theoretical premises to achieve technically efficient production of dialysis treatments in multiple product markets.

Commerce↗

Drugs and the pleura.

PURPOSE: To identify the drugs associated with pleural disease and to review the clinical, radiographic, and pleural fluid findings that occur, the natural history of the pleural reaction, and the response to therapy. DATA SOURCES: English-language articles published from January 1966 through April 1998 were identified through searches of the MEDLINE database, selective bibliographies, and personal files. DATA EXTRACTION: Case reports, letters, and review articles were assessed for relevancy. Reports of drug-associated pleural effusion, pleuritis, and/or pleural thickening were analyzed. Drug effect was believed to be causal when exposure induced pleural disease, when the pleural response remitted on discontinuation of the drug, and when the pleural disease recurred with reexposure. Drug association was inferred when the pleural disease occurred following drug exposure and remitted after drug discontinuation. The incidence, clinical presentation, dose and duration of drug therapy, chest radiographic findings, pleural fluid analysis, and response to therapy were recorded. CONCLUSIONS: A relatively small number of drugs were found to induce pleural disease when compared to the number of drugs implicated in causing disease of the lung parenchyma. Treatment of drug-induced pleural disease consists of drug therapy withdrawal and corticosteroids for refractory cases. Knowledge of the potential of drug-induced pleural disease will provide a clinical advantage to the physician and should lead to decreased morbidity and economic burden for the patient by avoidance of further diagnostic testing.

Humans↗

[ENT computerized medical history documentation. Report of experiences over 15 years].

The results of 15 years of automated data processing are evaluated, and methods used in the beginning are compared with present-day procedures. The standardisation of E.N.T. case histories, and direct access to data files (34 500 case histories) created a well functioning base for scientific research. Nevertheless, many problems had to be solved first; such as loss of data through careless manipulation, inadequate coding (analog data), insufficiency of date definition, as well as a reluctance to fill in questionnaires properly. The advent of increasingly user-friendly hardware and software has done much to narrow the gap between physician and computer. This is clearly demonstrated by the increased use of the E.N.T. data bank for research in the last few years.

Computers↗

A computerized system for describing the tests offered by a clinical laboratory.

A system has been developed which allows for the easy display of information concerning tests performed in the clinical laboratory. The system is designed for use at nursing stations as well as in the clinical laboratory. The information which can be displayed includes: 1) general information, such as sample type, tube type and minimum sample volume; (2) price charged for the test; (3) special instructions, such as sample transportation, hours when test is available, and sample collection information; (4) normal or reference values for the results. The programs are written in FORTRAN IV and, together with the data files, require 422 kilobytes of storage space.

Clinical Laboratory Techniques↗