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Data File: This month's column analyzes the results of the 1997 Capitation Survey conducted by the publisher of PSCR. While providers report ups and downs in Medicare PMPM rates from 1996 to 1997, utilization is clearly on the rise, signaling that providers need to beef up their medical management of resource-intensive seniors. Here are the highlights, plus details on ordering the full report.
Mitotic frequency in a synchronous culture of mammalian cells was determined fully automatically and in real time using low-intensity phase-contrast microscopy and a newvicon video camera connected to an EyeCom III image processor. Image samples, at a frequency of one per minute for 50 hours, were analyzed by first extracting the high-frequency picture components, then thresholding and probing for annular objects indicative of putative mitotic cells. Both the extraction of high-frequency components and the recognition of rings of varying radii and discontinuities employed novel algorithms. Spatial and temporal relationships between annuli were examined to discern the occurrences of mitoses, and such events were recorded in a computer data file. At present, the automatic analysis is suited for random cell proliferation rate measurements or cell cycle studies. The automatic identification of mitotic cells as described here provides a measure of the average proliferative activity of the cell population as a whole and eliminates more than eight hours of manual review per time-lapse video recording.
OBJECTIVE: To highlight data limitations, the need to improve data collection, the need to develop better analytic methods, and the need to use alternative data sources to conduct research related to the Medicare program. Objectives were achieved by reviewing existing studies on risk selection in Medicare HMOs, examining their data limitations, and introducing a new approach that circumvents many of these shortcomings. DATA SOURCES: Data for years 1995-97 for five states (Arizona, Florida, Massachusetts, New York, and Pennsylvania) from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs), maintained by the Agency for Healthcare Research and Quality; and the Health Care Financing Administration's Medicare Managed Care Market Penetration Data Files and Medicare Provider Analysis and Review Files. STUDY DESIGN: Analysis of hospital utilization rates for Medicare beneficiaries in the traditional fee-for-service (FFS) Medicare and Medicare HMO sectors and examination of the relationship between these rates and the Medicare HMO penetration rates. PRINCIPAL FINDINGS: Medicare HMOs have lower hospital utilization rates than their FFS counterparts, differences in utilization rates vary across states, and HMO penetration rates are inversely related to our rough measure of favorable selection. CONCLUSIONS: Substantial growth in Medicare HMO enrollment and the implementation of a new risk-adjusted payment system have led to an increasing need for research on the Medicare program. Improved data collection, better methods, new creative approaches, and alternative data sources are needed to address these issues in a timely and suitable manner.
An interactive graphics display system (IGDS) which presents perspective views of wire frame models is described. The display unit is a microprocessor driven TERAK 8510a system with a grid of 320 . 240 points. A brief discussion of the hardware is given. While the system is quite general - it can draw a perspective view of any type of wire frame model - emphasis here is on molecular models. The graphics software has been written in UCSD PASCAL. The program employs traditional computer graphics algorithms available in the literature, The data structure used by the program was designed to occupy minimal disk storage space. Data files can be constructed locally or can obtained through a communications link with with a central computer facility. Despite the inherent slowness (due to matrix operations being performed by the software calculations rather than hardware), the low cost of the system suggests general applicability. The program is easy to use, interactive, and produces good results from systems up to 200 points.
A microcomputer-based program for collecting and monitoring data on medication-dispensing errors made by pharmacy personnel is described, along with the policies and procedures for dealing with the responsible employees. The program was implemented at a 964-bed teaching hospital. When a medication-dispensing error is suspected, the director of pharmacy initiates a medication discrepancy follow-up report form. The appropriate supervisor fully investigates the incident, completes the form, and returns it to the director, who assigns a point value to the error on the basis of whether it injured or had the potential to injure the patient. Information from the report is then entered into an automated file. Data are sorted by the computer, allowing the performances of pharmacy personnel to be monitored. Progressive educational or disciplinary actions are taken depending on the number of points accumulated annually. Responsibility for an error is not assigned unless there is absolutely no question as to its origin, and dispensing-error points are not carried over from year to year. Since the program was implemented more than three years ago, the average number of reported medication-dispensing errors has decreased from 20 to 6 per month. Departmental procedures for monitoring and analyzing dispensing errors and for initiating disciplinary actions against personnel who commit many dispensing errors have been successful in creating greater awareness of the need to prevent such errors and in reducing their number.
The Bremen Mortality Index (BreMI) is an electronic data file providing all information found on death certificates of former Bremen citizens who have died after December 31, 1997. BreMI follows the example of the National Death Index (NDI) in the USA, which has provided information on the vital status of US citizens and cause of death since 1979. The Bremen Mortality Index has been linked successfully to the Bremen Cancer Registry and has improved the efficiency of following up cancer patients. A substantial number of death certificates may be checked automatically for the presence of a cancer diagnosis or any other diagnosis. The Bremen Mortality Index may be used as a primary source for data on particular causes of death. It will be used for developing a German thesaurus for automated coding of medical entities and for determining causes of death.
In 1987, New Zealand introduced a comprehensive Graduated Driver Licensing System (GDLS) which was designed to allow new drivers to gain driving experience while being excluded from high risk situations. This study sought to evaluate the impact of the GDLS on motorcycle traffic crashes that resulted in serious injury. Injury crash data were obtained from the New Zealand Health Information Services national public hospital inpatient data files for the years 1978-1994, inclusive. Cases were disaggregated into three age groups, 15-19 years, 20-24 years, and 25 years or older, for which injury trends were obtained. In order to determine whether trends in motorcycle traffic crashes simply followed national trends in other injury events, two non-traffic comparison groups for the main target group (15-19 years) were included. Using time series analyses, the introduction of the GDLS was found to be closely followed by a significant reduction (22%) in motorcycle traffic crash hospitalizations for the 15-19 year age group. An examination of vehicle registration and driver licensure data suggests that the reduction in injury crashes may, largely, be attributable to an overall reduction in exposure to motorcycle riding.
STUDY OBJECTIVE: The aim was to assess the value of bar coding, together with developed microcomputer programs, as a tool to speed up mailing and handling of return responses of a survey where over 4000 adolescents received a mailed questionnaire. DESIGN: Bar codes were used for displaying the identification number of a questionnaire, as well as each response alternative and number of the question. These bar codes were read by a wand, a handhold scanner, connected to a microcomputer and the data were automatically entered into a computer data file. RESULTS AND CONCLUSIONS: Compared with previous similar surveys, the use of bar codes did not seem to affect a manner of responding. Bar coding saved human steps in handling of return responses, reduced an error rate, and helped to control the process of work. Bar coding is recommended as a new technical tool for preparations of future large scale surveys.
An implementation of a Fuzzy Artmap neural network is used to detect and to identify (recognise) structures (patterns) embedded in the velocity field of a turbulent wake behind a circular cylinder. The net is trained to recognise both clockwise and anticlockwise eddies present in the u and v velocity fields at 420 diameters downstream of the cylinder that generates the wake, using a pre-processed part of the recorded velocity data. The phase relationship that exists between the angles of the velocity vectors of an eddy pattern is used to reduce the number of classes contained in the data, before the start of the training procedure. The net was made stricter by increasing the vigilance parameter within the interval [0.90, 0.95] and a set of net-weights were obtained for each value. Full data files were scanned with the net classifying patterns according to their phase characteristics. The net classifies about 27% of the recorded signals as eddy motions, with the strictest vigilance parameter and without the need to impose external initial templates. Spanwise distances (homogeneous direction of the flow) within the centres of the eddies identified suggest that they form pairs of counter-rotating vortices (double rollers). The number of patterns selected with Fuzzy Artmap is lower than that reported for template matching because the net classifies eddies according to the recirculating pattern present at the core or central region, while template matching extends the region over which correlation between data and template is performed. In both cases, the topology of educed patterns is in agreement.
The Observer 3.0 (Noldus, 1991) was used as the base for a time-saving fine analysis of animal behavior. A PC controlled a shuttlebox and a shuttlebox control unit. Learning behavior was recorded on videotapes by an S-VHS camcorder with vertical interval time code (VITC), which was used to generate an observational data file (ODF). The observational system was enhanced by automatically recorded status signals from the PC as event markers on the soundtrack of the videotape. These signals were used to subdivide a training session into numbered trials during generation of the ODF. They were later used for a PC-aided fine analysis of behavioral events, such as attention responses (AR) and orienting responses (OR) during shuttlebox learning. In this way, a large number of both automatically inserted PC event markers and manually inserted, key-defined behavioral events were registered and analyzed effectively in a semiautomatic fashion. The system is illustrated with an analysis of shuttle-box avoidance data from gerbils (Meriones unguiculatus).
We charted changes in the prescriptions issued to opiate addicts in treatment at a London clinic over the first 15 years of operation of one of the new National Health Service (NHS) drug clinics established in 1968. Having located the original handwritten ledger records of prescriptions issued by the drug addict treatment clinic, an SPSS data file was created of the prescriptions given to each of the clinic patients each month over the period 1968-1983 to permit examination of changes over this 15-year period in the drugs prescribed (e.g., heroin, methadone), the form (e.g., injectable or oral), the daily doses, and the extent of multiple items for single patients (e.g., both injectable ampule and oral forms). For each month, a list was available of all current patients detailing which drug(s) they had received during that month, in what form(s) and what dose(s). These items were the basic units of study. We report changes over the 15-year period for which the data were available. For the first 5 years, more than half of the prescriptions were for heroin (diamorphine hydrochloride), with the remainder of the prescriptions mostly comprising oral methadone. After 1973, methadone ampules for injection were increasingly commonly prescribed and thereafter remained at about a quarter of the prescriptions for the remaining 10 years for which data are available, whereas heroin prescriptions declined over the mid-1970s to only 20%. From 1973 onward, oral methadone was increasingly prescribed, rising from approximately one third of prescriptions in the early 1970s to more than two thirds by the early 1980s. Individual patients often received more than one drug or form of drug: From 1969 onward, oral methadone was commonly prescribed as a supplement to heroin prescriptions. This same practice was widespread with prescriptions for methadone ampules prescribed as a supplement to heroin prescriptions. Daily doses of heroin were at a mean of from 160 to 540 mg, in contrast with means of 20 to 40 mg and 25 to 50 mg daily for the injectable methadone ampules and the oral methadone solution, respectively. Major changes occurred in the prescribing practices of this London drug clinic over the first 15 years of operation of the new NHS clinics. However, these changes did not occur overnight and can be seen to have been gradual evolutions of practice with the preservation of heroin prescription through the first 5 years and the subsequent move to increased prescribing of injectable methadone, with both these practices being overtaken by the subsequent increased prominence of oral methadone syrup as the main drug prescribed. Reference to the original records reveals a more interesting picture than might be evident from the potentially selective recall of contemporary or historical commentators.
Registering the ingestive activity of laboratory animals can be carried out by using electronic scales connected to personal computers, thus gathering data files that allow calculation of the daily ingestion standards. The ingestion parameters most often used in the standard analysis include the number, size, and duration of the meals, the speed of ingestion, and intervals between feedings, and the hunger and satiation indexes. It is necessary to know a minimum interval between meals to distinguish between true meals and pauses within one and the same meal.
STUDY OBJECTIVE: To describe the epidemiology of serious non-fatal firearm injury in New Zealand. METHODS: Cases of nonfatal firearm-related injury were extracted from the hospital inpatient data files of the New Zealand Health Information Service for the period 1979 to 1992 inclusive. RESULTS: There were 1,239 firearm-related injuries, or 2.7 injuries per 100,000 population per year. Males, persons aged 15 to 24 years, certain occupational groups, and persons living in rural environments had higher rates of injury. Unintentional incidents accounted for 64% of the injuries. At least 25% of the incidents involved shotguns, and a further 20% involved rifles. CONCLUSION: The results presented here serve to support the attention that has been given to prevention of firearm injuries in New Zealand. Priority should be given to establishment of a surveillance system that would provide uniform data on firearm-related mortality and morbidity to aid in risk factor research and development and evaluation of intervention programs.
The minimal model approach to analysis of intravenous glucose tolerance tests (IVGTT) yields estimates of parameters representing insulin sensitivity, glucose-mediated glucose disposal and pancreatic responsiveness. The precision of these estimates can deteriorate if the glucose and insulin data lack well-defined structure or freedom from data noise (random error). The precision of parameter estimates can be enhanced if data sets from two or more IVGTTs, obtained under different experimental conditions in the same subject, are analysed together in one data file. Following initial fitting using CONSAM, the conversational version of the modeling program SAAM, those parameters whose estimates remain at the same value under the different experimental conditions are constrained. This effectively reduces the number of adjustable parameters, and their estimates can then be fine-tuned with enhanced precision using the batch version of SAAM.
Proteomics research programs typically comprise the identification of protein content of any given cell, their isoforms, splice variants, post-translational modifications, interacting partners and higher-order complexes under different conditions. These studies present significant analytical challenges owing to the high proteome complexity and the low abundance of the corresponding proteins, which often requires highly sensitive and resolving techniques. Mass spectrometry plays an important role in proteomics and has become an indispensable tool for molecular and cellular biology. However, the analysis of mass spectrometry data can be a daunting task in view of the complexity of the information to decipher, the accuracy and dynamic range of quantitative analysis, the availability of appropriate bioinformatics software and the overwhelming size of data files. The past ten years have witnessed significant technological advances in mass spectrometry-based proteomics and synergy with bioinformatics is vital to fulfill the expectations of biological discovery programs. We present here the technological capabilities of mass spectrometry and bioinformatics for mining the cellular proteome in the context of discovery programs aimed at trace-level protein identification and expression from microgram amounts of protein extracts from human tissues.
Achalasia is an uncommon esophageal motility disorder of unknown etiology. To gain insights into possible etiologic risk factors, demographic and comorbidity data were obtained from Medicare hospital discharge data files from 1986-1989 on patients aged 65 and older. Age-adjusted sex- and race-specific occurrence rates were calculated for each US state. The rate of comorbid illness occurrence in achalasia patients was compared to that of the entire hospitalized Medicare population. Records of 15,000 achalasia discharges were available for analysis. Achalasia discharge rates increased linearly from age 65 to 94 years. They were similar in males and females as well as whites and nonwhites. High rates were observed in the South and low rates in most states of the East North Central region around the Great Lakes and in the Pacific region. The same geographic pattern was observed in men and women as well as in the two separate subsets of data representing the periods 1986-1987 and 1988-1989. Achalasia was associated with a significantly increased risk for pulmonary complications, malnutrition, and gastroesophageal cancer. The concordant occurrence of achalasia in patients with Parkinson's disease, depressive disorder, and various other myoneural disorders indicated a possible etiologic relationship. Achalasia appears to represent the clinical end point of several different pathways. Besides aging, different neurologic diseases may contribute to a loss in control of esophageal motility. The geographic pattern could suggest the influence of environmental factors.
Influenza is an important cause of mortality in temperate countries, but there is substantial controversy as to the total direct and indirect mortality burden imposed by influenza viruses. The authors have extracted multiple-cause death data from public-use data files for the United States from 1979 to 2001. The current research reevaluates attribution of deaths to influenza, by use of an annualized regression approach: comparing measures of excess deaths with measures of influenza virus prevalence by subtype over entire influenza seasons and attributing deaths to influenza by a regression model. This approach is more conservative in its assumptions than is earlier work, which used weekly regression models, or models based on fitting baselines, but it produces results consistent with these other methods, supporting the conclusion that influenza is an important cause of seasonal excess deaths. The regression model attributes an annual average of 41,400 (95% confidence interval: 27,100, 55,700) deaths to influenza over the period 1979-2001. The study also uses regional death data to investigate the effects of cold weather on annualized excess deaths.
OBJECTIVE: To compare clinically relevant pharmacokinetic, pharmacodynamic and toxico logical characteristics of calcium-modulating compounds used in ischemic heart disease. DATA SOURCES: A MEDLINE search (1990 pt B to 1991 pt A revised for 1993; 1991 pt B to 1992 revised for 1993; and January to May 1993) combining the search phrases 'calcium channel blockers', 'myocardial ischemia', 'pharmacodynamics' and 'pharmacokinetics', and a search in Compact Cambridge Drug Information Source vol-6 (revised 1992, fourth quarter) using the search phrase 'calcium antagonists' and medical subject headings (MeSH) 'pharmacokinetics' and 'pharmacodynamics' were used to obtain title and abstract information on available current literature. STUDY SELECTION: Review articles, proceedings and studies published in English and available within the University of Saskatchewan library system, as they appeared to relate closely to the objective, were obtained for closer evaluation. In addition, primary references were examined, and journal reprints were selected from the authors' files. DATA EXTRACTION: The focus was on studies and objective reviews that profiled one or more representative compounds in a manner suitable for deriving background and comparative information pertaining to the objective. Data from multiple studies, or from studies that employed multiple methodological approaches, were preferentially extracted and summarized for presentation. DATA SYNTHESIS: The role of calcium in cardiac and vascular smooth muscle physiology was reviewed, highlighting the major mechanisms responsible for maintaining calcium homeostasis in these cells. With a focus on verapamil, diltiazem and 1,4-dihydropyridines currently employed in the treatment of cardiovascular disorders, a general survey of their sites of action, tissue selective pharmacodynamics, pharmacokinetic properties and side effects was undertaken in a comparative context. CONCLUSIONS: Calcium antagonists are employed in the treatment of angina, certain cardiac arrhythmias and hypertension. They are a chemically and pharmacologically heterogeneous group of compounds that act principally to inhibit the influx of calcium across certain voltage-dependent membrane channels. Concepts pertaining to calcium mobilization in the pathophysiology of myocardial ischemia, particularly at the molecular level, have evolved remarkably over the past decade. The repertoire of agents having calcium-regulating properties has expanded in parallel. The task of integrating new knowledge in both of these areas requires further attention in order to determine optimal approaches to treatment.