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PubMed2006

A data mining approach in home healthcare: outcomes and service use.

BACKGROUND: The purpose of this research is to understand the performance of home healthcare practice in the US. The relationships between home healthcare patient factors and agency characteristics are not well understood. In particular, discharge destination and length of stay have not been studied using a data mining approach which may provide insights not obtained through traditional statistical analyses. METHODS: The data were obtained from the 2000 National Home and Hospice Care Survey data for three specific conditions (chronic obstructive pulmonary disease, heart failure and hip replacement), representing nearly 580 patients from across the US. The data mining approach used was CART (Classification and Regression Trees). Our aim was twofold: 1) determining the drivers of home healthcare service outcomes (discharge destination and length of stay) and 2) examining the applicability of induction through data mining to home healthcare data. RESULTS: Patient age (85 and older) was a driving force in discharge destination and length of stay for all three conditions. There were also impacts from the type of agency, type of payment, and ethnicity. CONCLUSION: Patients over 85 years of age experience differential outcomes depending on the condition. There are also differential effects related to agency type by condition although length of stay was generally lower for hospital-based agencies. The CART procedure was sufficiently accurate in correctly classifying patients in all three conditions which suggests continuing utility in home health care.

Aftercare↗
PubMed2000

Accuracy of physical and occupational therapists' early predictions of recovery after severe middle cerebral artery stroke.

INTRODUCTION: The ability of physical therapists (PTs) and occupational therapists (OTs) to predict level of outcome accurately was investigated prospectively in 91 severely disabled stroke patients with a first-ever middle cerebral artery (MCA) stroke. METHODS: Within the second and fifth week after stroke onset, 364 predictions were made by 59 PTs and 47 OTs about walking ability, dexterity, activities of daily living (ADL), need for additional care in ADL, time required to achieve independent walking ability and maximal level of ADL, and destination of discharge at six months after stroke. The functional recovery patterns of stroke patients were assessed by an independent observer. The accuracy of the therapists' predictions was compared with that of derived prediction models. In addition, the influence of characteristics of patients and therapists on the accuracy of the predictions was investigated. RESULTS: Compared to observed outcomes at six months after stroke, therapists' lowest accuracies of prediction were found for the moment at which maximal ADL score was achieved (rs = 0.07; p = NS), and highest accuracy was for level of dexterity of the hemiplegic arm (rs = 0.78; p <0.01). Therapists' predictions of functional outcome at six months tended to be too pessimistic. No significant differences were observed for dexterity and walking ability when the predictions by PTs and OTs were compared with those of regression models, whereas significant differences were found for the accuracies of OTs' and PTs' first prediction of destination of discharge and second predictions of outcome in ADL and need for additional care in ADL. No significant differences were found between the accuracy of PTs' and OTs' predictions, and their ability to predict functional outcome was not significantly influenced by the characteristics of patient and therapists. CONCLUSIONS: At two and five weeks after stroke, OTs and PTs can accurately predict level of walking ability and dexterity at six months. The prediction of time required for achieving maximal level of recovery, destination of discharge, outcome of ADL as well as need for additional care in ADL leaves room for improvement.

Activities of Daily Living↗
PubMed1994

Differential expression of Broad-Complex transcription factors may forecast tissue-specific developmental fates during Drosophila metamorphosis.

The steroid hormone ecdysone initiates metamorphosis in Drosophila melanogaster by activating a cascade of gene activity that includes primary response transcriptional regulators and secondary response structural genes. The Broad-Complex (BR-C) primary response gene is composed of several distinct genetic functions and encodes a family of related transcription factor isoforms. Our objective was to determine whether BR-C isoforms were components of the primary ecdysone response in all tissues and whether tissue-specific isoform expression is associated with tissue-specific metamorphic outcomes. We used specific antibody reagents that recognize and distinguish among the Z1, Z2 and Z3 BR-C protein isoforms to study protein expression patterns during the initial stages of metamorphosis. Western blot analyses demonstrated that BR-C isoforms are induced at the onset of metamorphosis, each with unique kinetics of induction and repression. Whole-mount immunostaining showed that the BR-C proteins accumulate in the nuclei of all larval and imaginal tissues indicating that the BR-C is induced as a primary response in many tissues. Several tissues express different levels and combinations of the BR-C isoforms suggesting that the BR-C is important in determining the tissue-specific outcome of many parallel ecdysone response cascades. For example, prepupal salivary glands (destined for histolysis during metamorphosis) express Z1 isoforms while imaginal discs (destined for cell differentiation and morphogenesis) shift from the synthesis of Z2 isoforms to the synthesis of Z1 isoforms. The prepupal central nervous system (destined for tissue remodeling) expresses all isoforms, with Z3 predominating. Salivary gland chromosome immunostaining indicated that BR-C proteins interact directly with numerous loci in the polytene genome. Finally, western blot analyses showed that distinct BR-C genetic functions can be correlated with single and specific BR-C protein isoforms.

Animals↗
PubMed1998

The spatial relationships among cutaneous, muscle sensory and motoneuron axons during development of the chick hindlimb.

Previous studies have suggested that interactions with other axons are important in sensory axon pathfinding in the developing chick hindlimb. Yet the nature of these interactions remains unknown, in part because information about the spatial relationships among the different kinds of axons is lacking. To obtain this information, we combined retrograde axonal tracing with an immunofluorescent labelling approach that distinguishes between sensory and motoneuron axons. This allowed us to follow the trajectories of sensory axons having a known destination, while also identifying their neighbors. We found that as sensory and motoneuron axons meet in the spinal nerves and travel into the limb, sensory axons remain bundled together. The large bundles that are present proximally gradually split into smaller bundles as the axons course distally in the spinal nerves; more distally, some bundles join to again form large bundles. Younger, later-growing sensory axons appear to grow primarily along bundles of older sensory axons that grew out earlier. Starting from very proximal levels, axons projecting along an individual cutaneous nerve are found together in bundles that are situated in characteristic regions of each spinal nerve. Some of these bundles are initially interspersed with bundles of axons projecting along other nerves, thereby indicating that the initial position of a cutaneous axon in the spinal nerves does not strictly determine its subsequent trajectory. As they travel distally, bundles of axons projecting along one cutaneous nerve gradually join one another, becoming increasingly separated from axons having different destinations. In contrast, muscle sensory axons are situated adjacent to motoneuron axons innervating the same muscle for much of their course. This suggests that muscle sensory axons may be guided to the appropriate muscles by fasciculating along motoneuron axons. Taken together, the results show that sensory axons projecting along different nerves are different from one another and respond to cues in their environment to navigate through the spinal nerves and plexus. Thus, sensory neurons must be intrinsically specified with respect to their peripheral targets. Sensory axons appear to respond differentially to the axons they encounter, segregating from axons that project along different nerves and often growing with axons destined for the same nerve, suggesting that fasciculation may aid pathfinding.

Animals↗
PubMedDate not supplied

Risks of hepatitis B in travelers as compared to immunization status.

BACKGROUND: Our objective was to determine the risks of infection with hepatitis B among European travelers and to compare this with the immunization status in various risk groups. METHODS: A cross-sectional telephone questionnaire survey of randomly selected subjects, in nine European study populations was used. A total of 9, 008 individuals were involved, with approximately 1,000 interviews conducted in each country in the native languages. Situations with a high risk of hepatitis B infection, such as invasive medical procedures, attending to a bleeding person, and skin perforating cosmetic practices, particularly when performed in countries with medium/high transmission risk, and vaccination status of travelers, were the main outcome measures. RESULTS: Depending upon the destination, 6.6-11.2% of travelers were classified as at high risk of hepatitis B, with 24.4% vaccinated; between 60.8-75.8% of travelers at potential risk, with 19.2% vaccinated; and 33.4% of travelers where no hepatitis B risk was identified. Significantly more travelers who only visited medium/high endemicity regions exposed themselves to a high risk of contracting hepatitis B, (40, 10.5%) compared to travelers who only visited low endemicity regions (225, 6.6%; p <.01). CONCLUSIONS: A significant proportion of travelers surveyed unwittingly exposed themselves to the risk of hepatitis B infection while at medium/high risk destinations. The majority of at-risk travelers had not been vaccinated, regardless of their destination. Improved advice and clear recommendations to avoid transmission are needed.

Adolescent↗
PubMed1990

Prevention of travellers' diarrhoea by Lactobacillus GG.

A placebo-controlled double-blind study was conducted on the efficacy of Lactobacillus GG in preventing travellers' diarrhoea. Altogether 820 persons travelling on holiday to southern Turkey to two destinations were randomized into two groups receiving either Lactobacillus GG or placebo in identical sachets. On the return flight each participant completed a questionnaire indicating the incidence of diarrhoea and related symptoms during the trip. Of the original group 756 (92%) subjects completed the study acceptably. The overall incidence of diarrhoea was 43.8% (331 cases). The total incidence of diarrhoea in the placebo group was 46.5% and in the Lactobacillus GG 41.0% indicating an overall protection of 11.8%. Protection rates varied between two different destinations with the maximum protection rate reported as 39.5%. Among older age groups there was significantly less diarrhoea when compared to younger travellers. Lactobacillus GG appeared to be effective in reducing the occurrence of travellers' diarrhoea in one of the two destinations with no side effects.

Adolescent↗
PubMedDate not supplied

TGN38 cycles via the basolateral membrane of polarized Caco-2 cells.

TGN38 is a heavily glycosylated, type I integral membrane protein which is predominantly localized to the trans Golgi network (TGN), but which constitutively traffics between the TGN and the cell surface. The trafficking of TGN38 has been extensively studied in non-polarized cells, and a short, tyrosine-based, peptide motif within the cytosolic domain of the protein has been shown to be necessary and sufficient for its rapid internalization from the cell surface and efficient delivery to the TGN. Such tyrosine-based motifs have also been shown to act as basolateral targeting signals, whilst N-linked glycans (as occur on the extracytosolic domain of TGN38) can act as apical targeting signals. TGN38 has previously been shown to be sorted to the basolateral surface of polarized canine MDCK cells; a polarized cell line in which biosynthetic sorting decisions concerning the eventual destination of apical or basolateral targeted plasma membrane proteins are made at the TGN. We now show that TGN38 is targeted exclusively to the basolateral domain of polarized human Caco-2 cells, a cell line in which newly synthesized membrane proteins destined for either the apical or basolateral plasma membrane may be sorted for delivery to their final destination either at the TGN or at the cell surface. These data also demonstrate that the heavily glycosylated, extracytosolic domain of TGN38 does not contain a dominant apical targeting signal.

Animals↗
PubMed2000

[Tropical diseases and imported disorders in 1763 patients seen at the Outpatient Clinic for Tropical Diseases, Academic Medical Center, Amsterdam (1996-1997)].

OBJECTIVE: To describe an analysis of the patients seen at the Outpatient Department (OPD) for Tropical Diseases in the Academic Medical Centre, Amsterdam, during 1996 and 1997. DESIGN: Descriptive cross-sectional study. METHOD: From our database of OPD-patients the following data were analysed: age, country of birth, travel destination and most frequent complaints at presentation. These were further analysed in relation to travel destination, diagnosis and need of admission. RESULTS: In 1996 and 1997 1763 patients visited the OPD. Abdominal complaints, fever, general malaise and skin diseases were the main problems. Abdominal complaints were more often acquired in Asia, fever in sub-Saharan Africa and skin problems in South America. General malaise was not related to a specific travel destination. Abdominal complaints, fever and general malaise were more often caused by parasites, and skin problems by bacteria. Plasmodia were the most frequently encountered microbial cause. Malaria was found in 1 out of every 3 Dutch, and 9 out of every 10 Ghanaian patients with fever from Africa. CONCLUSION: The analysis of the database yielded useful information regarding patients with import diseases in the Netherlands and with respect to travellers to tropical areas.

Academic Medical Centers↗
PubMedDate not supplied

Contextual marketing--the real business of the Internet.

The painful truth is that the Internet has been a letdown for most companies--largely because the dominant model for Internet commerce, the destination Web site, doesn't suit the needs of those companies or their customers. Most consumer product companies don't provide enough value or dynamic information to induce customers to make the repeat visits--and disclose the detailed information--that make such sites profitable. In this article, David Kenny and John F. Marshall suggest that companies discard the notion that a Web site equals an Internet strategy. Instead of trying to create destinations that people will come to, companies need to use the power and reach of the Internet to deliver tailored messages and information to customers. Companies have to become what the authors call "contextual marketers." Delivering the most relevant information possible to consumers in the most timely manner possible will become feasible, the authors say, as access moves beyond the PC to shopping malls, retail stores, airports, bus stations, and even cars. The authors describe how the ubiquitous Internet will hasten the demise of the destination Web site--and open up scads of opportunities to reach customers through marketing "mobilemediaries," such as smart cards, e-wallets, and bar code scanners. The companies that master the complexity of the ubiquitous Internet will gain significant advantages: they'll gain greater intimacy with customers and target market segments more efficiently. The ones that don't will be dismissed as nuisances, the authors conclude. They suggest ways to become welcome additions--not unwelcome intrusions--to customers' lives.

Commerce↗
PubMed1975

Volume, characteristics and consequences of internal migration in Colombia.

More than one-third of the Colombian population can be classified as migrants. The prevailing direction of movements is urbanwards, yet it is significant that better than a third of all movements are to rural destinations. Nationwide comparisons of migrants and residents on demographic characteristics would indicate that all streams are selective of the younger and unmarried population, with women predominating in urbanwards movements and men in those to rural areas. However, when compared in terms of socioeconomic characteristics, migrants are more sharply differentiated among themselves than they are from the resident population at each of their respective destinations. Within the migrant population, a natural funneling of the more able migrants to the largest centers suggests itself. Migrants have consistently higher activity rates than the remainder of the population and, in the case of men at least, appear capable of competing for jobs on an equal basis with residents at their respective destinations. Female migrants, however, are consistently overrepresented in lower-status activities, particularly in domestic services.

Adolescent↗
PubMed1984

Migration and intervening opportunities.

An analysis of factors affecting migration is presented. The authors "extend the investigation of the roles of information, intervening opportunities, and psychic costs by focussing on differences in migrant destinations with respect to the deterring effect of distance. [They develop] a reservation-wage model of migration which implies that the distance effect is weaker for high-wage destinations and stronger for low-wage destinations." The model is tested using data for Brazil, Japan, Mexico, the United States, and Venezuela.

Americas↗
PubMed1987

On the move: migration, urbanization and development in Papua New Guinea.

"Migration and urbanization data from Papua New Guinea's first truly national census in 1980 are considered against a backdrop of spatial and social inequalities. Source and destination factors affecting migration flows and destinations are found to relate to population density, availability of rural wages, ease of access, destination wage-earning opportunities, historical linkages and present day developments. Short-distance migration differs from longer-distance migration; many migrants are short-term, and possibly circular, migrants. Migration and urbanization are considered part of the same process of developmental change." A section is included on earlier censuses and surveys, data reliability, and related problems.

Censuses↗
PubMed2000

[Are there health risks for travel among Tunisians? What type of medical care should be assured?].

The present work aims to assess the importance of the international travels of Tunisians, their destinations, the risks they face as well as the means to reduce them. Therefore, data related to the period from 1989 to 1998, were collected from official organisms involved in this area. Results revealed an increase of the number of Tunisians travelling outside the country of 23% between 1989 and 1998, with a mean progress of 5.7% per year since 1993. Main destinations were Maghrebin countries (65.7%), Europe (30%) and Middle East (4%). The number of persons leaving to high risk destinations remains difficult to assess and shows the importance of implementing a surveillance system to insure an adequate medical follow-up of this category of travellers. The structures actually involved in the health management of Tunisian travellers have a weak recruitment which demonstrates the importance to strengthen the sensitization of general practitioners to this subject and the promotion of the immunization ward of "Institut Pasteur" to a national centre of travelling medicine.

Aftercare↗
PubMed1992

[Factors facilitating the return of the elderly to their homes after discharge from a geriatric intermediate care facility].

Geriatric intermediate care facilities (GICFs) were started with subsidies from the Ministry of Health and Welfare in 1987 to encourage return of the elderly from hospitals to their homes rather than other destinations such as nursing homes or hospitals. Contrary to the initial expectation, only half of users (the elderly) have returned home. In order to examine the factors influencing destination after discharge from GICFs, characteristics of the users of a GICF and their primary caregivers were analyzed in a rural community in Nagano. The users were grouped according to their discharge destinations (i.e. 1: home, 2: hospital, 3: nursing home and other GICFs) and compared with respect to the users' and caregivers' socio-demographic characteristics, the length of stay, the users' activities of daily living (ADL) and mental status, the type of place before admission and after discharge, and the caring capacity of the family (i.e. manpower, housing conditions, household economic level and social support). A multiple logistic regression analysis revealed that the following factors were correlated to their return home: good ADL, a short admission period, good level of health of caregivers, adequate space in the residence, negative perception of the caregivers regarding the costs of GICF, and economic level of the household. Evaluation of these factors at an early stage of admission to GICFs may enable prediction of whether or not a user can be successfully discharged to return home.

Aged↗
PubMed1990

Robotic transportation.

Mobile robots perform fetch-and-carry tasks autonomously. An intelligent, sensor-equipped mobile robot does not require dedicated pathways or extensive facility modification. In the hospital, mobile robots can be used to carry specimens, pharmaceuticals, meals, etc. between supply centers, patient areas, and laboratories. The HelpMate (Transitions Research Corp.) mobile robot was developed specifically for hospital environments. To reach a desired destination, Help-Mate navigates with an on-board computer that continuously polls a suite of sensors, matches the sensor data against a pre-programmed map of the environment, and issues drive commands and path corrections. A sender operates the robot with a user-friendly menu that prompts for payload insertion and desired destination(s). Upon arrival at its selected destination, the robot prompts the recipient for a security code or physical key and awaits acknowledgement of payload removal. In the future, the integration of HelpMate with robot manipulators, test equipment, and central institutional information systems will open new applications in more localized areas and should help overcome difficulties in filling transport staff positions.

Hospital Departments↗
PubMed1988

[Basic and clinical studies of angiotensin II pressor responsiveness in pregnancy-induced-hypertension].

This paper shows the basic and clinical evaluations of pressor responsiveness to angiotensin II (A II) using A II sensitivity test (AST) in normotensive and hypertensive pregnant women. The results are as follows: I. Basic findings of A II pressor responsiveness 1. AST was performed sequentially from as early in gestation as possible throughout the remainder of pregnancy. At clinic visit the patients received A II infusions sufficient to raise baseline diastolic blood pressure by 20 mmHg. The dose (ng/kg/min) of A II required to elevate 20 mmHg of diastolic blood pressure was recorded as the EPD. Increased EPD indicates the dullness of refractoriness to A II. The EPD in normotensive women (non-PIH) increased as early as midpregnancy, but EPD in women destined to develop pregnancy-induced-hypertension (PIH) decreased significantly after the 20th week of gestation. 2. Plasma angiotensin level in non-PIH increased significantly compared to that of PIH. There exists a definite correlation between EPD in pregnant women and plasma angiotensin level. 3. The plasma TxB2/6-keto-PGF1 alpha ratio increased significantly in PIH compared with that of non-PIH because of the increase in the amount of TxB2. In the 2nd trimester, the ratio in women destined to developed PIH showed a significantly higher value than that of the non-PIH. 4. In healthy men and castrated rats the EPD significantly increased after the administration of progesterone. At 20 and 30 weeks' gestation, the plasma progesterone/estrogen ratio in women destined to develop PIH decreased significantly compared to that of the non-PIH.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed1996

Evaluation of travel and use as a risk factor for seropositivity to Ehrlichia risticii in horses of New York state.

OBJECTIVES: To determine whether mean annual frequency and destination of equine travel was associated with exposure to Ehrlichia risticii and whether these associations were modified by horses' place of residence. DESIGN: Cross-sectional study. SAMPLE POPULATION: 511 equine operations containing 2,587 horses were visited in New York state from a target population of 39,000 operations. PROCEDURE: Each horse was tested for serum antibodies against E risticii, using indirect fluorescent antibody. Information on the horse's travel history, farm's management practices, and surrounding ecology was obtained by personal interview and resource maps. Statistical analyses were performed on 2 cohorts of animals: all horses enrolled in the study and horses born on the property or that resided at least 4 years on the farm. Three county-based risk regions (RR) were identified by use of cluster analysis. RESULTS: Mean seroprevalence for each of the 3 RR was 2.4 (low risk), 8.5 (moderate risk), and 18.5% (high risk) for cohort 1 and 2.5, 8.0, and 18.4% for cohort 2. Among cohorts 1 and 2, pleasure riding and breeding trips were associated with exposure to E risticii, but horse residence (low, moderate, or high RR) was an effect modifier for these associations. Among cohort 1 and stratifying the analysis according to the RR for the travel destination, trail riding at low RR and trail riding at high RR were associated with exposure. Among cohort 2 and stratifying the analysis according to the RR for the travel destination, breeding trips were associated with exposure, and strong effect modification was present for horse residence (low, moderate, or high RR). CONCLUSIONS: Only certain types of travel to specific RR were associated with higher risk of exposure to E risticii. In many instances, travel was not associated, or was associated, with a reduced risk of exposure.

Animals↗
PubMed1996

Hepatitis A infection in aircrews: risk of infection and cost-benefit analysis of hepatitis A vaccination.

BACKGROUND: Since a hepatitis A vaccine (HAV) with long-lasting efficacy has become available, its indication in airline crews needs to be determined. HYPOTHESIS: Destinations in developing countries are a risk factor for hepatitis A infection in airline crews, and vaccination is cost-beneficial. METHODS: Retrospective analysis was performed for all Swissair medical files for the period 1987-91. Denominator and cost data were obtained by the personnel department, and a cross-sectional seroepidemiological survey was performed in 734 Sabena staff. RESULTS: Among 3,322 Swissair crewmembers who spent an average of 45 nights in developing countries, 22 hepatitis A infections occurred. For the non-immune crewmembers, the overall annual incidence rate was 1.53 per 1000, whereas the incidence rate while staying in a high risk country was 12.2 per 1000. Cockpit crews with destinations limited to Europe had a rate of zero. Male flight attendants had a threefold higher rate as compared to female flight attendants or pilots. In Sabena, anti-HAV seroprevalence was 33.3%. Increased rates were observed in male as compared to female flying crews and in employees stationed abroad, whereas flying personnel had no higher rate than ground personnel. Simplified comparison of cost of infection and cost of vaccination indicates that vaccination may be cost-saving to the airline company for both male flight-attendants and pilots. CONCLUSIONS: Hepatitis A vaccination may be recommended to staff stationed in high risk countries and to flying crews with such destinations.

Adult↗