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At least 595 records · Page 33Linked to original sources
PubMed1987

Medicaid recipients in intermediate care facilities for the mentally retarded.

In this study, we examined Medicaid utilization and expenditure patterns of Medicaid recipients in intermediate care facilities for the mentally retarded (ICF's/MR) in three States: California, Georgia, and Michigan. Data were obtained from uniform Medicaid data files (Tape-to-Tape project). Most recipients in ICF's/MR were nonelderly adults with severe or profound mental retardation who were in an ICF/MR for the entire year. The average annual cost of care ranged from $26,617 per recipient in Georgia to $36,128 per recipient in Michigan. The vast majority of recipients were low utilizers of other Medicaid services. Approximately one-third of the recipients were also covered by Medicare.

Adult↗
PubMed2005

Interindividual variation in nucleotide excision repair genes and risk of endometrial cancer.

Exposure to estrogens is a likely cause of endometrial cancer, but the means by which estrogens exert this effect are not entirely clear. One hypothesis is that certain estrogen metabolites bind to the DNA, forming bulky adducts that damage the DNA and initiate carcinogenesis. A woman's reduced capacity to repair such damage may increase her risk of endometrial cancer. We conducted a population-based case-control study in western Washington State to address the role of variation in nucleotide excision repair genes on the risk of endometrial cancer. Case women (n = 371), ages 50 to 69 years, were diagnosed with invasive endometrial cancer between 1994 and 1999. Control women (n = 420) were selected using random-digit dialing (ages 50-65 years) and by random selection from Health Care Financing Administration data files (ages 66-69 years). Genotyping assays were done for ERCC1, ERCC2 (XPD), ERCC4 (XPF), ERCC5 (XPG), XPA, and XPC. No appreciable differences between cases and controls were observed in the genotype distributions of ERCC1 (c8092a and c19007t), ERCC2 (D312N, K751Q, and c22541a), ERCC4 (R415Q and t30028c), or ERCC5 (D1104H). Carriage of at least one variant allele for XPA G23A was associated with decreased risk of endometrial cancer [odds ratio (OR), 0.70; 95% confidence interval (95% CI), 0.53-0.93]. Carriage of at least one XPC A499V variant allele was associated with a modest decrease in risk (OR, 0.79; 95% CI, 0.59-1.05). Women with variant alleles at both XPC A499V and K939Q had 58% of the risk of women with no XPC variant alleles (OR, 0.58; 95% CI, 0.35-0.96). Our data suggest that interindividual variation in XPA and XPC influences a woman's risk of endometrial cancer.

Aged↗
PubMedDate not supplied

[Infantile nutritional evaluation with the software EPI INFO (version 6.0), taking into consideration collective and individual approaches, degree and type of malnutrition].

OBJECTIVE: A systematization for an anthropometric infantile evaluation is proposed, employing the software Epi Info, version 6.0, considering the collective and individual approaches, as well as the degree and type of malnutrition. METHODS: The software Epi Info, sponsored by the World Health Organization, provides an infantile nutritional evaluation, which is based on three anthropometric indicators: weight-for-age, height-for-age and weight-for-height. In order to quantify the observed data of each individual, three scales can be used. Among them, the Z score, which discriminates more efficiently the severe cases, is employed as a first choice. The reference pattern of the NCHS is used. Many cutoff points between eutrophy and malnutrition can be chosen, but the -2 Z score is the most employed. The child can be classified in three diagnostic categories: stunting, for height-for- age deficits; wasting, for weight-for-height deficits; underweight, for weight-for-age deficits. Besides this, in a collective approach, the Epi Info software calculates the proportion of individuals in each populational group which have their anthropometric data deviated from the reference curve, constituting the percentage of observed abnormality (called standardized prevalence). RESULTS: In this paper, in which the analysis of a data file is presented as an example, the organization of the information provided by Epi Info is proposed, with the characteristics described below. In order to increase the diagnostic sensitivity, the collective approach is valued. Concerning the type of malnutrition, the English term "stunting" is substituted by "chronic malnutrition", "wasting" by "acute malnutrition" and "underweight" by "isolated weight deficit". Concerning the degree of malnutrition, the -2 and -3 Z scores are employed as cutoffs in order to define, respectively, a threshold between the moderate and severe forms. CONCLUSIONS: The proposed approach takes into account the identification of all forms of malnutrition, from the mildest to the most severe cases, takes into consideration both height and weight deficits and if the process is acute or chronic. Therefore, it is a tool for organizing data available with the use of the computer.

English Abstract↗
PubMed1989

A population study of the relationship between fetal death and altered fetal growth.

In order to describe the relationship between fetal death rate and impaired fetal growth, we examined over 850,000 births in Illinois between 1980-1984 (using the state computer data file) and assessed the mean/modal birth weights at each gestational age and the relationship between birth weight and fetal death rate at each gestational age. We were interested in the following questions: 1) Is the relationship between impaired fetal growth and fetal death rate the same at each gestational age? and 2) What birth weight would result in a quadrupling of the fetal death rate at each gestational age? Using exponential regression analysis, we determined for each gestational age the fetal death rate at the modal birth weight and similarly, the birth weight expected to result in a quadrupling of the fetal death rate. As gestational age advanced, the birth weight percentile resulting in the constant outcome also increased (second percentile at 25 weeks; 17th percentile at 42 weeks). We also compared these data with similar data from Denver. The findings indicate the following: 1) Fetal death rate increases exponentially as birth weight decreases at each gestational age; 2) the birth weight percentile that results in a constant outcome is not consistent at each gestational age; and 3) if assessment of risk is to be inferred based on the relationship between birth weight and gestational age, the tenth percentile (whether Denver, Illinois, or elsewhere) does not predict stillbirth accurately. The implications point to the use of outcome-oriented risk assessments to predict fetal death when examining the relationship between birth weight and gestational age.

Birth Weight↗
PubMed2005

Ascertainment of gastroschisis using the ICD-9-CM surgical procedure code.

OBJECTIVE: To determine the effectiveness of using the ICD-9-CM procedure code 54.71 for case ascertainment of gastroschisis. METHODS: Using procedure code 54.71, we queried a statewide hospital discharge database to identify all cases coded as undergoing surgical repair of gastroschisis. Each retrieved case was verified as having gastroschisis by review of the hospital record. All gastroschisis cases were then matched to the Florida Birth Defect Registry (FBDR) dataset. This registry uses a passive system of multiple data sources and employs the ICD-9-CM diagnostic code 756.79 to identify gastroschisis and other abdominal wall defects. RESULTS: Of 93 cases identified by using code 54.71, 92 were confirmed by record review to have gastroschisis. The FBDR identified 87 of the 92 cases (95%). The FBDR missed three of the remaining five cases because of linkage difficulties between inconsistent data elements in the respective data files. The other two cases were not identified by the FBDR because the source database (AHCA discharge) truncates the entry of ICD-9-CM diagnostic codes when more than 10 of them are listed in the medical record. CONCLUSIONS: Use of the surgical procedure code was demonstrated to be superior to the diagnostic code as a method for identification of gastroschisis cases. The same approach may be useful in the detection of malformations other than gastroschisis.

Adult↗
PubMed2005

SeqState: primer design and sequence statistics for phylogenetic DNA datasets.

Choosing and designing primers based on available DNA sequence data and statistical contrasting of domains or structural features is a common routine among molecular biologists. Currently available, free software tools were found to lack desirable features related to these tasks. This was the motivation for developing a new program, SeqState. SeqState locates regions that remain to be sequenced in phylogenetic DNA datasets, evaluates user-provided primers and selects primers best suited to fill gaps in the sequences. If the primers provided by the user are unsuitable, new primers are designed. Primers can be loaded from a primer database, be supplied as part of the alignment or be entered manually. The position of internal primers is automatically localised in the loaded data file. Primers can be edited, and changes and new primers can be saved to the database. Primer sheets allow the user to view internal dimers, complements to a second primer, mismatches to all loaded sequences, and other primer characteristics. Calculation of various sequence statistics can be requested for the whole dataset or parts thereof (character sets), with standard errors estimated by bootstrapping. Insertion-deletion events can be evaluated statistically and encoded for subsequent phylogenetic analysis according to several published coding principles.

Algorithms↗
PubMed2006

The UCSC Known Genes.

The University of California Santa Cruz (UCSC) Known Genes dataset is constructed by a fully automated process, based on protein data from Swiss-Prot/TrEMBL (UniProt) and the associated mRNA data from Genbank. The detailed steps of this process are described. Extensive cross-references from this dataset to other genomic and proteomic data were constructed. For each known gene, a details page is provided containing rich information about the gene, together with extensive links to other relevant genomic, proteomic and pathway data. As of July 2005, the UCSC Known Genes are available for human, mouse and rat genomes. The Known Genes serves as a foundation to support several key programs: the Genome Browser, Proteome Browser, Gene Sorter and Table Browser offered at the UCSC website. All the associated data files and program source code are also available. They can be accessed at http://genome.ucsc.edu. The genomic coverage of UCSC Known Genes, RefSeq, Ensembl Genes, H-Invitational and CCDS is analyzed. Although UCSC Known Genes offers the highest genomic and CDS coverage among major human and mouse gene sets, more detailed analysis suggests all of them could be further improved.

Base Sequence↗
PubMed1996

Anticoagulant related complications in elderly patients with St. Jude mechanical valve prostheses.

BACKGROUND AND AIMS OF THE STUDY: This communication reports the anticoagulant-related complications (ARH) in patients who received the St. Jude Medical mechanical prosthesis and were 70 years of age or older at the time of implantation. METHODS: Our institutional data file shows that during the 15-year period from 1977 to 1992, our group implanted the St. Jude Medical mechanical prosthesis in 610 patients with aortic valve disease (AVR) and 186 patients with mitral disease (MVR), who were 70 years or older, either with or without coronary artery bypass grafts. The operative mortality was 6.4% for AVR and 16% for MVR. The mean follow up for this elderly group was 4.9 years (2,996 patient-years) for AVR and 4.2 years (771 patient-years) for MVR. RESULTS: The incidence of late death was 30% for AVR and 33% for MVR. The freedom from TE was 91.6% +/- 1.8%, from valve thrombosis 98.8% +/- 0.7%, and from ARH 95.9% +/- 1.1%. The freedom from operative death, valve-related death, and all complications was 78.8% +/- 2.4%. The data from this study shows that both the aortic and the mitral valve replacement patients who were 70 years or older have an acceptable rate of bleeding complications. Reduction of the intensity of anticoagulation in our practice (INR of 1.8-2.5 for AVR and 2.5-3.2 for MVR) may play a role in this finding. The incidence of valve thrombosis and TE rates were also low in this study. CONCLUSIONS: With increasing life expectancy in the elderly, the use of the St. Jude Medical Mechanical prosthesis and low intensity anticoagulation could be reconsidered for a selected group of elderly patients.

Aged↗
PubMed1993

Displaying radiologic images on personal computers.

This is the second article of our series for radiologists and imaging scientists on displaying, manipulating, and analyzing radiologic images on personal computers (PCs). The first article discussed the digital image data file, standard PC graphic file formats, and various methods for importing radiologic images into the PC. This article discusses the hardware, software, and user interface issues related to displaying gray scale images on PCs. In particular, this segment focuses on the process of converting the digital image into gray shades on a color monitor. A method for displaying and interactively setting the window width and window level parameters of 16-bit radiologic images on PCs with standard red green blue graphic hardware is illustrated in a sample application.

Computer Graphics↗
PubMed1995

A paradigm for computer-assisted radiology resident rotation scheduling.

RATIONALE AND OBJECTIVES: The scheduling of radiology residents remains a major annual undertaking of chief residents. In this article, we describe a paradigm to implement interactive computer programs to reduce the inefficiencies and inequities of planning the yearly schedule. METHODS: We used the programming language, Prolog, to develop a compact program that provides faster and more flexible performance than those reported in the literature. This interactive program stores scheduling requirements in data files separated from the control program and runs on a Macintosh computer. RESULTS: The schedule of any residency year is generated within 3-7 sec. The fast computation and query capabilities of this scheduling program have helped chief residents to identify conflicting requirements that were previously overlooked. CONCLUSION: Using our programming paradigm, we have developed a portable Prolog-based scheduling program that is quick and easy to use.

Cost-Benefit Analysis↗
PubMed1989

The bacteriophage T2 and T4 DNA-[N6-adenine] methyltransferase (Dam) sequence specificities are not identical.

Bacteriophages T2 and T4 encode DNA-[N6-adenine] methyltransferases (Dam) which differ from each other by only three amino acids. The canonical recognition sequence for these enzymes in both cytosine and 5-hydroxymethylcytosine-containing DNA is GATC; at a lower efficiency they also recognize some non-canonical sites in sequences derived from GAY (where Y is cytosine or thymine). We found that T4 Dam fails to methylate certain GATA and GATT sequences which are methylated by T2 Dam. This indicates that T2 Dam and T4 Dam do not have identical sequence specificities. We analyzed DNA sequence data files obtained from GenBank, containing about 30% of the T4 genome, to estimate the overall frequency of occurrence of GATC, as well as non-canonical sites derived from GAY. The observed N6methyladenine (m6A) content of T4 DNA, methylated exclusively at GATC (by Escherichia coli Dam), was found to be in good agreement with this estimate. Although GATC is fully methylated in virion DNA, only a small percentage of the non-canonical sequences are methylated.

Base Sequence↗
PubMed1999

Serum dehydroepiandrosterone sulfate concentration and thyroid cancer risk: a matched case control study.

In animal models of carcinogenesis, pharmacological doses of dehydroepiandrosterone (DHEA) treatment appear to reduce the incidence of chemically induced thyroid cancers. DHEA and its sulfate (DHEA-S) are secreted in approximately equal amounts, but serum levels of DHEA-S are 300-500 times higher and have no diurnal variation when compared to DHEA. The hypothesis that serum concentrations of DHEA-S may be associated with thyroid cancer risk was tested in a population-based prospective case control study. Data from the practically complete nationwide Cancer Registry of Norway were linked to the data file of a serum bank comprising blood samples from 300,000 Norwegian men and women obtained through national health surveys. A total of 113 donors, who during the years after blood sampling received a diagnosis of thyroid cancer, were identified in the serum bank and were eligible for the study. Each case was matched with 3 controls. Serum levels of DHEA-S were determined blindly. Controls were divided into tertiles, and odds ratios between cases and controls were determined relative to the group with the lowest serum DHEA-S level. The risk of developing thyroid cancer was determined in women 50 years of age or older, in women below age 50, in men, and in the subgroup of 77 cases who had morphologically verified papillary thyroid cancer. No significant association between prediagnostic serum DHEA-S concentrations and thyroid cancer risk was observed. These data indicate that DHEA-S within physiological concentrations does not reduce the risk of thyroid cancer.

Adult↗
PubMed1991

[Computer-assisted analysis of the results of training in internal medicine].

Analysis of the results of teaching of clinical disciplines has in the long run an impact on the standard and value of medical care. It requires processing of quantitative and qualitative data. The selection of indicators which will be followed up and procedures used for their processing are of fundamental importance. The submitted investigation is an example how to use possibilities to process results of effectiveness analysis in teaching internal medicine by means of computer technique. As an indicator of effectiveness the authors selected the percentage of students who had an opportunity during the given period of their studies to observe a certain pathological condition, and as method of data collection a survey by means of questionnaires was used. The task permits to differentiate the students' experience (whether the student examined the patient himself or whether the patient was only demonstrated) and it makes it possible to differentiate the place of observation (at the university teaching hospital or regional non-teaching hospital attachment). The task permits also to form sub-groups of respondents to combine them as desired and to compare their results. The described computer programme support comprises primary processing of the output of the questionnaire survey. The questionnaires are transformed and stored by groups of respondents in data files of suitable format (programme SDFORM); the processing of results is described as well as their presentation as output listing or on the display in the interactive way (SDRESULT programme). Using the above programmes, the authors processed the results of a survey made among students during and after completion of the studies in a series of 70 recommended pathological conditions. As an example the authors compare results of observations in 20 selected pathological conditions important for the diagnosis and therapy in primary care in the final stage of the medical course in 1981 and 1985.

Data Collection↗
PubMed2000

Birth weight and altitude: a study in Peruvian communities.

We tested the hypothesis that at high altitude birth weight decreases once a critical barometric pressure (Pb) is reached. Birth weight data covering the 1-year period from November 1997 to October 1998 were collected in Peru from the data files of 15 community and mining centers between sea level and 4575 m altitude. These centers are scattered along the main road that joins Lima (on the Pacific shore) to Cerro de Pasco (4330 m) and surroundings. Above approximately 2000 m (ie, at Pb below approximately 590 mm Hg, inspired O(2) partial pressure of approximately 114 mm Hg) and up to approximately 4500 m altitude birth weight declined at an average of 65 g for every additional 500 m altitude (or 105 g for every additional 50 mm Hg drop in Pb). This pattern did not differ between sexes. Averages and modal distributions of the birth weight from 2 hospitals in Cerro de Pasco (4330 m) serving different social groups were similar. Body length at birth was similar at various altitudes, with the exception of the 2 highest locations above 4500 m, where it was slightly reduced. From these data, together with additional data collected in the North of Peru (Chacas, 3360 m) and with results from other ethnic groups previously published, we conclude that the drop in birth weight at altitude is (1) apparent once the critical Pb of approximately 590 mm Hg is reached, corresponding to an altitude of approximately 2000 m, (2) proportional to the increase in altitude between approximately 2000 m and 4500 m, and (3) independent from socioeconomic factors.

Altitude↗
PubMed2005

Preliminary results of neural networks and zernike polynomials for classification of videokeratography maps.

PURPOSE: Our main goal in this work was to develop an artificial neural network (NN) that could classify specific types of corneal shapes using Zernike coefficients as input. Other authors have implemented successful NN systems in the past and have demonstrated their efficiency using different parameters. Our claim is that, given the increasing popularity of Zernike polynomials among the eye care community, this may be an interesting choice to add complementing value and precision to existing methods. By using a simple and well-documented corneal surface representation scheme, which relies on corneal elevation information, one can generate simple NN input parameters that are independent of curvature definition and that are also efficient. METHODS: We have used the Matlab Neural Network Toolbox (MathWorks, Natick, MA) to implement a three-layer feed-forward NN with 15 inputs and 5 outputs. A database from an EyeSys System 2000 (EyeSys Vision, Houston, TX) videokeratograph installed at the Escola Paulista de Medicina-Sao Paulo was used. This database contained an unknown number of corneal types. From this database, two specialists selected 80 corneas that could be clearly classified into five distinct categories: (1) normal, (2) with-the-rule astigmatism, (3) against-the-rule astigmatism, (4) keratoconus, and (5) post-laser-assisted in situ keratomileusis. The corneal height (SAG) information of the 80 data files was fit with the first 15 Vision Science and it Applications (VSIA) standard Zernike coefficients, which were individually used to feed the 15 neurons of the input layer. The five output neurons were associated with the five typical corneal shapes. A group of 40 cases was randomly selected from the larger group of 80 corneas and used as the training set. RESULTS: The NN responses were statistically analyzed in terms of sensitivity [true positive/(true positive + false negative)], specificity [true negative/(true negative + false positive)], and precision [(true positive + true negative)/total number of cases]. The mean values for these parameters were, respectively, 78.75, 97.81, and 94%. CONCLUSION: Although we have used a relatively small training and testing set, results presented here should be considered promising. They are certainly an indication of the potential of Zernike polynomials as reliable parameters, at least in the cases presented here, as input data for artificial intelligence automation of the diagnosis process of videokeratography examinations. This technique should facilitate the implementation and add value to the classification methods already available. We also discuss briefly certain special properties of Zernike polynomials that are what we think make them suitable as NN inputs for this type of application.

Artificial Intelligence↗
PubMed2003

An analysis of osteoporosis-related hip fractures using hospital discharge data.

The purpose of this study was to assess whether physicians in practice inadequately diagnose osteoporosis in a high-risk population of postmenopausal women who have sustained hip fractures. Using the Texas Hospital Discharge Data-Public Use Data File (PUDF) provided through the Texas Health Care Information Council, the authors conducted a review of all postmenopausal women older than 55 years with fractured hips discharged from Texas hospitals during 1999. A total of 13,628 patients meeting these criteria were found using the PUDF. In their diagnoses, physicians for 2233 (16.3%) of these 13,628 women also specified the code for osteoporosis (P < .001) from the ninth revision of the International Classification of Diseases. It is estimated that between 40% and 50% of postmenopausal women have osteoporosis. Therefore, women with fragility fractures form an even more at-risk subset of the population--so much so that one would expect a majority of these women to carry diagnoses of osteoporosis. The age distribution in each group was comparable, implying that receiving a coded diagnosis for osteoporosis was not related to the age of the patient when she was admitted to the hospital. Further, when data was analyzed by race or ethnicity, percentages for each group (ie, diagnosed with hip fracture only versus diagnosed with hip fracture and osteoporosis) were comparable. In conclusion, physicians practicing in Texas during calendar year 1999 inadequately diagnosed osteoporosis in a high-risk population of postmenopausal women who were admitted to hospitals with fractured hips. Future analysis of subsequent annual databases will identify whether continuing medical education efforts cause physicians to diagnosis osteoporosis in this high-risk population more frequently.

Aged↗
PubMed2001

Gated blood pool tomography for the evaluation of global and regional left ventricular function in comparison to planar techniques and echocardiography.

BACKGROUND: Multigated radionuclide ventriculography (MUGA) is a simple and reliable tool for the assessment of global systolic and diastolic function and in several studies it is still considered a standard for the assessment of left ventricular ejection fraction. However the evaluation of regional wall motion by MUGA is critical due to two-dimensional imaging and its clinical use is progressively declining in favor of echocardiography. Tomographic MUGA (T-MUGA) is not widely adopted in clinical practice. The aim of this study was to compare T-MUGA to planar MUGA (P-MUGA) for the assessment of global ejection fraction and to transthoracic echocardiography for the evaluation of regional wall motion. METHODS: A 16-segment model was adopted for the comparison with echo regional wall motion. For each one of the 16 segments the normal range of T-MUGA ejection fraction was quantified and a normal data file was defined; the average value -2.5 SD was used as the lower threshold to identify abnormal segments. In addition, amplitude images from Fourier analysis were quantified and considered abnormal according to three different thresholds (25, 50 and 75% of the maximum). RESULTS: In a study group of 33 consecutive patients the ejection fraction values of T-MUGA highly correlated with those of P-MUGA (r = 0.93). The regional ejection fraction (according to the normal database) and the amplitude analysis (50% threshold) allowed for the correct identification of 203/226 and 167/226 asynergic segments by echocardiography, and of 269/302 and 244/302 normal segments, respectively. Therefore sensitivity, specificity and overall accuracy to detect regional wall motion abnormalities were 90, 89, 89% and 74, 81, 79% for regional ejection fraction and amplitude analysis, respectively. CONCLUSIONS: T-MUGA is a reliable tool for regional wall motion evaluation, well correlated with echocardiography, less subjective and able to provide quantitative data.

Echocardiography↗
PubMed2005

CaSPredictor: a new computer-based tool for caspase substrate prediction.

MOTIVATION: In vitro studies have shown that the most remarkable catalytic features of caspases, a family of cysteineproteases, are their stringent specificity to Asp (D) in the S1 subsite and at least four amino acids to the left of scissile bound. However, there is little information about the substrate recognition patterns in vivo. The prediction and characterization of proteolytic cleavage sites in natural substrates could be useful for uncovering these structural relationships. RESULTS: PEST-like sequences rich in the amino acids Ser (S), Thr (T), Pro (P), Glu or Asp (E/D), including Asn (N) and Gln (Q) are adjacent structural/sequential elements in the majority of cleavage site regions of the natural caspase substrates described in the literature, supporting its possible implication in the substrate selection by caspases. We developed CaSPredictor, a software which incorporated a PEST-like index and the position-dependent amino acid matrices for prediction of caspase cleavage sites in individual proteins and protein datasets. The program predicted successfully 81% (111/137) of the cleavage sites in experimentally verified caspase substrates not annotated in its internal data file. Its accuracy and confidence was estimated as 80% using ROC methodology. The program was much more efficient in predicting caspase substrates when compared with PeptideCutter and PEPS software. Finally, the program detected potential cleavage sites in the primary sequences of 1644 proteins in a dataset containing 9986 protein entries. AVAILABILITY: Requests for software should be made to Dr José E. Belizário SUPPLEMENTARY INFORMATION: Supplementary information is available for academic users at site http://icb.usp.br/~farmaco/Jose/CaSpredictorfiles.

Algorithms↗