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At least 775 records · Page 43Linked to original sources
PubMed2001

Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients?

UNLABELLED: France was the first country to promote the extensive use of buprenorphine for the treatment of drug-addicted subjects through the primary care system. To assess both professional commitment and patients' characteristics, all the physicians and pharmacists of a French area having prescribed/dispensed buprenorphine from 2/12/96 (the official release date) to 1/31/98 were identified from data files of the Health Insurance and then interviewed. During the first 61 weeks of buprenorphine maintenance treatment (BMT), 27.5% of physicians and 51.2% of pharmacists of that area were involved; 142 patient records were documented. Features of the clinical routines spontaneously implemented for practice-based BMT were: a high level of on-site supervised dispensation by the pharmacist (71% at treatment induction and 23% thereafter); the absence of objective measurement of illicit drug use; and a low buprenorphine dosage. These features are consistent with the lack of physicians' experience and training, and also the relatively good status of the population treated (no HIV-positives, heroin use duration averaging 4.2 +/- 3.1 years, and 81.7% with stable accommodations). Despite liberal regulations guiding BMT, a negligible proportion of cases had a "nomadic" attitude (multiple buprenorphine prescribers/deliverers). The treatment outcomes (no deaths, three drug overdoses, improvement in occupational status) are encouraging. CONCLUSION: Practice-based BMT appears to be a safe and acceptable response to moderate heroin addiction, but further training of the professionals involved and longitudinal investigations of individual outcomes are needed.

Adult↗
PubMed2000

Family risk factors versus peer risk factors for drug abuse. A longitudinal study of an African American urban community sample.

This study compared the influence of family problems with influence of deviant and delinquent social behavior and peer relationships up to the time of the 16th birthday as risk factors for substance use, for lifetime up to age 26. Control variables for the analysis were available from the National Collaborative project's longitudinal data file, collected from time of birth, on the African American community study sample (N = 380). A key finding was that the social behavior and peer relationship problems accounted for 18.8% of the additional variance in later degree of substance use, whereas the family problems accounted for only 5.1% of the additional variance in later degree of substance use.

Adolescent↗
PubMed1996

Abdominal aortic aneurysm repair in Veterans Affairs medical centers.

PURPOSE: This study was performed to define outcomes after abdominal aortic aneurysm (AAA) repair in Veterans Affairs (VA) medical centers during fiscal years 1991 through 1993. METHODS: With VA patient treatment file data, patients were selected from diagnosis-related groups 110 and 111 and were then classified in a patient management category. In the categories of repair of nonruptured and ruptured AAA, mortality and postoperative complication rates were defined for patients who underwent AAA repair in VA medical centers during the 3-year study period. RESULTS: Hospital mortality rates were 4.86% (166 of 3419) after repair of nonruptured AAA and 47.0% (126 of 268) after repair of ruptured AAA (p<0.001). Of 292 deaths after AAA repair, 136 (43.2%) followed repair of ruptured AAA, even though ruptured AAA comprised only 7.3% of total AAA surgical volume. AAA repairs were performed at 116 VA medical centers, with 31.8+/-23.1 (range, 1 to 140) procedures performed at each center. Although many lower-volume centers had excellent results, centers that performed >or=32 AAA repairs tended to have lower in-hospital mortality rates after repair of nonruptured AAA than those that performed <or=31 procedures (4.2%+/-3.5% compared with 6.7%+/-7.8%;p<0.05). Poisson regression analysis revealed an inverse relationship between the volume of AAA repairs and individual hospital mortality (p=0.001) and a direct relationship between illness severity and hospital mortality (p=0.008). The proportion of ruptured AAAs treated in a hospital was also directly related to individual hospital mortality rates (p<0.005). Postoperative complications were associated with an increased hospital mortality rate (11.7% with complication compared with 6.5% without; p<0.0001) and length of stay (23.6+/-17.1 days compared with 18.0+/-12.4 days; p<0.0001). In a logistic regression model, increased mortality rates after AAA repair were associated with hospital type (adjusted odds ratio [OR]=0.6), increasing age (OR=1.1), patient management category severity score (OR=2.2), hemorrhage (OR=2.3), myocardial infarction (OR=2.6), disseminated intravascular coagulation (OR=4.7), AAA rupture (OR=6.0), postoperative shock (OR=10.7), cardiopulmonary arrest (OR=15.4), central nervous system complications (OR=16.0) and urologic complications (OR=2.4). CONCLUSIONS: Mortality rates after AAA repair in VA hospitals were comparable with those previously reported in other large series. Outcomes for veterans with AAA may improve by referring patients eligible for elective repair to VA medical centers with a greater operative volume or to lower-volume centers that have had excellent results.

Age Factors↗
PubMed2003

Risk factors for physical assault. State-managed workers' compensation experience.

BACKGROUND: The estimation of incidence and evaluation of risk factors associated with nonfatal occupational assault injuries have rarely been documented in a statewide population context. A state-managed workers' compensation system can provide estimates of incidence of such injuries and allow evaluation of risk factors. METHODS: Using claims data from the state-managed West Virginia Workers' Compensation, the incidence rates of workplace injuries resulting from physical assault were estimated for the period 1997-1999. Data on potential risk factors were obtained from the claim-related electronic data files, and the risk associated with each factor was assessed using proportional injury ratios (PIRs). RESULTS: During the study period, 2122 compensated injuries were associated with workplace violence. The incidence of assault injuries was 108.2 cases per 100,000 employee years. Women sustained a higher incidence than men. Healthcare workers, public safety workers, and teachers accounted for almost 75% of all assault injuries. Workers in these occupations also differed from each other with regard to seasonality and timing of assault, perpetrator-victim relationship, and types of injury. Evidence of gender-occupation interaction indicated higher risk of assault injury in men compared to women across the three leading occupations. Nighttime work shifts were associated with greater risk of assault for female healthcare workers (PIR=1.8; 95% confidence interval, 1.09-2.87). CONCLUSIONS: The healthcare sector sustained the bulk of assault injuries in West Virginia. Although the majority of healthcare-sector employees were women, the risk of assault injuries was higher in male employees. Risk factors and injury characteristics identified in this study, particularly for three high-risk occupations, should help develop strategies for preventing workplace violence. Protecting female healthcare workers on night-shift duty, especially in nursing home settings, appears to be an important target for intervention.

Female↗
PubMed1998

Building public health goals into the purchasing process: the Missouri Medicaid agency as purchaser.

INTRODUCTION: As managed care radically changes the medical care environment, public health leaders are under increasing pressure to focus more on core public health functions and less on personal health services. As public health re-evaluates its key strategies, it can take advantage of its strategic role in purchasing medical care to forge new partnerships that benefit its constituents. METHODS: Specific roles for public health in medical care purchasing are discussed. The state of Missouri is used as an example of successful strategies for positioning public health as a leader in the managed care environment. Key strategies include increasing influence in contracting; selecting and reporting of key health status indicators; promoting use of population-based data files; taking leadership roles in government-sponsored insurance programs; and assuring stability of critical health conditions during managed care transitions. CONCLUSION: Public health has unprecedented opportunities to develop new methods for improving health status. Public health's well-developed scientific principles and methods, combined with strategic leadership, will position the discipline in the forefront of the dialogue about our nation's health system into the next century.

Contract Services↗
PubMed1998

DoEpi. Computer-assisted instruction in epidemiology and computing and a framework for creating new exercises.

DoEpi is a series of computer exercises and a framework for making new exercises based on the Epi Info programs for epidemiologic computing. The system contains three outbreak investigations, a research survey, four exercises in advanced Epi Info programming, and four exercises in public health surveillance. The exercises are available via the Internet (www.cdc.gov, under "Publications, Products, and Software") with provision for CME and CEU credit from the Centers for Disease Control and Prevention. They can serve as a useful adjunct to lectures and textbooks in teaching epidemiology or epidemiologic computing. A new DoEpi exercise with hypertext, low-resolution photographs, questions, answers, and an examination can be constructed in hours rather than weeks or months using an Exercise Development "wizard" provided as part of the instructor's module. Epi Info exercises with data files and customized programs require more work to construct but can be added by those with the necessary skills. DoEpi exercises can be used in a variety of ways for different curricula and students of different background levels, including those with English as a second language. Translation of DoEpi exercises into other languages is facilitated by the instructor's module, and construction of new exercises with locally suitable materials is encouraged. DoEpi is based on DOS programs to allow the widest use. The format lends itself to conversion to hypertext programs in the Microsoft Windows and Internet formats at a future date.

Centers for Disease Control and Prevention, U.S.↗
PubMed2001

Measurement variation of aortic pulse wave velocity in the elderly.

Accurate and reproducible measures are required to study arterial stiffness in human populations. The reproducibility of aortic pulse wave velocity was evaluated in 14 participants from a population-based study of cardiovascular disease in the elderly. Three data files were collected per participant by each of two sonographers and files were read by two readers. Seven of the 14 participants returned for a second visit 1 week later to assess between-visit variability. Reproducibility was evaluated with Pearson and intraclass correlations and by the absolute value of the difference between replicate values. The overall reliability coefficient was rI = 0.77. Between-sonographer, between-reader, and between-visit correlations were rP = 0.80 to 0.87, rP = 0.73 to 0.89 and rP = 0.63. The mean absolute value of the difference between replicates was 59.4 to 94.0 cm/sec and 88.7 to 112.8 cm/sec for sonographers and readers, respectively. These results indicate that the mean PWV measure is reproducible even when sonographers and readers are newly trained.

Aged↗
PubMed1999

Compliance with LTOT and consumption of mobile oxygen.

The aim of the study was to investigate compliance with long-term oxygen therapy (LTOT), the consumption of mobile oxygen and factors that might influence on these measures. The study included 182 patients with LTOT and 125 patients answered a questionnaire on daily activities. Information on arterial gas tension, lung function, and diagnosis was obtained from the medical file. Data on oxygen systems and the actual usage of oxygen were obtained from the oxygen suppliers. Seventy-six per cent of the patients had a concentrator and 35% had both stationary and mobile oxygen. Good compliance (use of oxygen > 15 h day-1) was seen in 65%. Of the tested factors, only mobile oxygen had an influence on the effective usage. Outdoor activity was reported in 65% of the patients. Only 48% of these patients had mobile units, while 21% of the home-bound patients had mobile units. Of the patients with mobile oxygen, only 39% used their mobile unit > 2 h week-1. Poorer usage of stationary oxygen was observed in patients with outdoor activity (2.4 hours day-1 less). Although only 16 (13%) patients reported a usage less than 15 h day-1, the actual consumption was less than 15 h day-1 in 29%. In conclusion, patients on LTOT tended to overestimate their oxygen usage. Acceptable compliance was observed in 65% of the patients. Only mobile oxygen had a significant impact on the overall compliance. As more patients had outdoor activities than expected, and as these activities had a negative impact on the usage of stationary oxygen, more attention must be paid on detecting outdoor activities. However, as fewer than half of the patients with outdoor activity and mobile oxygen used their mobile systems, there is a need for measures to improve compliance with mobile oxygen. Using lists referring to the actual usage and discussing the usage with the patients may improve the compliance and cost-benefit.

Adolescent↗
PubMed1997

Commissioning of enhanced dynamic wedge on a ROCS RTP system.

The enhanced dynamic wedge (EDW) is clinically commissioned on a ROCS RTPS (Version 5.03) in a manner similar to that used for any standard physical wedge. The required data set for implementation includes central axis depth dose, and open and wedge beam profiles at several depths and output factors. The features distinguishing the EDW from the physical wedge are a sharp change in output with field size in the wedge plane and a primary intensity difference at the end of the wedge field because the moving jaw stops 0.5 cm short of the fixed jaw position for all field sizes, for safety reasons. The monitor unit (MU) calculation for an EDW field in ROCS is based on scaling factors that are derived from a normalized golden STT (NGSTT). This approach requires no change in the data file structure of ROCS. It was found that the output for EDW is very sensitive to the value of final moving jaw position. Every 0.5 cm difference between planned and set value can cause 3.5% error.

Radiotherapy Planning, Computer-Assisted↗
PubMed2000

The new prompt gamma-ray catalogue for PGAA

A new catalogue of subthermal neutron-induced prompt gamma rays has been created for 79 elements, from hydrogen to uranium (including fission), on the basis of recent measurements at the Budapest guided-neutron PGAA facility. New energy values have been measured using 35Cl neutron-capture gamma rays, while the gamma-ray production cross-sections have been determined with respect to the 1H thermal capture cross-section. The elemental data have been compared with thermal neutron-capture data for individual nuclides from the Evaluated Nuclear Structure Data File, ENSDF, hence isotope identifications could be made. The catalogue contains elemental spectra and a table with nearly 7000 gamma rays with relative intensity over 1% of the strongest line. The average accuracy is about 0.08 keV for energies and about 5% for cross-sections in the whole energy range, from about 40 keV to 11 MeV.

Journal Article↗
PubMedDate not supplied

Half-life measurements at the National Institute of Standards and Technology.

For nearly half a century the half-lives of many radionuclides have been measured with increasing precision. The results of these measurements for many long-lived radionuclides, such as 60Co, 137Cs, 85Kr, 133Ba, 207Bi, 152Eu, 154Eu, and 155Eu, have been updated recently by the Radioactivity Group of NIST. These long-lived radionuclides are used extensively to calibrate various nuclear counting and monitoring systems. The long-term precision of these calibrations can be greatly affected by the uncertainties in the calibrant half-lives. Results for the half-lives of many radionuclides measured over the last four decades are tabulated. In addition, values of the half-lives of several short-lived radionuclides used in nuclear medicine are addressed, which are critical in determining the correct dosage given in patient treatment, are addressed. Comparisons with the recommended values from the International Atomic Energy Agency Coordinated Research Program and the Evaluated Nuclear Structure Data File from Brookhaven National Laboratory are presented and any apparent disagreements noted.

Journal Article↗
PubMed2000

Calibration of the National Institute of Standards and Technology tritiated-water standards

Massic activity values obtained for NBS/NIST tritiated water SRMs 4927 and 4927E, using internal gas-proportional counting, are reported. The massic activity ratios of all of the available NBS/NIST tritiated water SRMs and samples of the Level 1 and Level 3 tritiated water standards produced by the National Physical Laboratory (NPL) in 1996 were measured using an extensive series of liquid-scintillation intercomparisons. New massic activity values obtained for the NPL standards, using the gas counting results for SRM 4927E and the results of the liquid-scintillation intercomparison, are also reported. A new determination of the half-life of tritium was made using massic activity data for SRM 4927 over a period of 38 years. The new value is (4504+/-9) (one standard deviation) days. This value differs significantly from the previous NBS/NIST value but is in good agreement with the value recommended in the Evaluated Nuclear Structure Data File (ENSDF).

Journal Article↗
PubMed2003

Breast cancer surveillance using gridded population units, Connecticut, 1992 to 1995.

PURPOSE: To assess geographic variation in invasive breast cancer across Connecticut using gridded population areas to enumerate cases and the population at-risk. METHODS: The state's land mass was divided into 5168, 1-by-1 square mile areas and the population of women, 20+ years of age, within each location was estimated by areal interpolation of the 1990 US Census Block Group STF-3A data file. Using information on breast cancer incidence, 1992 to 1995, from the Connecticut Tumor Registry, latitude-longitude coordinates for place of residence at the time of breast cancer diagnosis were determined for 8530 records and assigned to appropriate grid locations. A spatial scan statistic was used to detect variation in incidence and test the significance of observed differences across the state. Standardized Incidence Ratios (SIRs) described the proportional change in the age-adjusted breast cancer incidence rate across gridded locations. RESULTS: The statewide age-adjusted invasive cancer incidence rate was 163.6/100,000 women/year. The spatial scan statistic identified three locations around Connecticut with significantly low incidence rates and four places where rates were significantly high. The most probable place of low incidence was rural Northeastern Connecticut where risk of disease, relative to elsewhere around the state, was 0.73 (p = 0.001). The most probable location of elevated incidence was a suburban location in Southwestern Connecticut with a relative risk of 2.02 (p = 0.001). CONCLUSIONS: Visual representation of disease incidence and underlying populations at-risk according to gridded units provides a useful tool for assessing small area variation in disease patterns.

Adult↗
PubMed2002

IMIRS: a high-resolution 3D reconstruction package integrated with a relational image database.

Recent advances in electron cryomicroscopy instrumentation and single particle reconstruction have created opportunities for high-throughput and high-resolution three-dimensional (3D) structure determination of macromolecular complexes. However, it has become impractical and inefficient to rely on conventional text file data management and command-line programs to organize and process the increasing numbers of image data required in high-resolution studies. Here, we present a distributed relational database for managing complex datasets and its integration into our high-resolution software package IMIRS (Image Management and Icosahedral Reconstruction System). IMIRS consists of a complete set of modular programs for icosahedral reconstruction organized under a graphical user interface and provides options for user-friendly, step-by-step data processing as well as automatic reconstruction. We show that the integration of data management with processing in IMIRS automates the tedious tasks of data management, enables data coherence, and facilitates information sharing in a distributed computer and user environment without significantly increasing the time of program execution. We demonstrate the applicability of IMIRS in icosahedral reconstruction toward high resolution by using it to obtain an 8-A 3D structure of an intermediate-sized dsRNA virus.

Animals↗
PubMed2003

Functional evidence of reversible ischemic injury immediately after the sympathetic storm associated with experimental brain death.

BACKGROUND: Acute brain death from increased intracranial pressure results in a transient increase in myocardial adenosine and lactate, which indicates that oxygen demand exceeds oxygen delivery during the sympathetic "storm". The aim of this study was to determine the functional significance of this period of ischemia. METHODS: Brain death was inflicted on 40 Westran pigs (36.5-68.0 kg) by inflating a 21-ml subdural balloon over 3 minutes. In 38 animals, micromanometry and sonomicrometry were used to obtain left ventricular pressure-volume loops to determine the preload recruitable stroke work (PRSW) relationship. Data files were recorded before and at 15-minute intervals after beginning balloon inflation. Plasma troponin I was measured before and 60 minutes after beginning balloon inflation in the 38 instrumented and 2 non-instrumented animals. RESULTS: All animals experienced the classical sympathetic storm. The slope of the PRSW relationship decreased, and the volume-axis intercept shifted to the right 15 minutes after beginning balloon inflation (p < 0.0001). Progressive incremental recovery (leftward shift) occurred between subsequent time points (p < or = 0.0018). In the instrumented animals, the mean plasma troponin I level increased from 1.4 +/- 1.6 microg/liter to 2.8 +/- 2.3 microg/liter (p < 0.001). However, troponin I was not detected before or after induction of brain death in the plasma of either non-instrumented animal (p = 0.001). CONCLUSIONS: The sympathetic storm produced transient contractile dysfunction, consistent with ischemic injury. However, troponin I release reflected surgical instrumentation and not brain death.

Animals↗
PubMed1998

Historical databases in Scandinavia.

"Researchers and archivists in Denmark, Sweden, and Norway have created several databases containing transcripts of historical, nominative sources such as censuses and ministerial records. In this way they continue a century-long tradition of record keeping that tracks virtually every Nordic citizen. The characteristics of the databases differ from country to country, however, requiring different research strategies in each. This article reviews how the data bases are built, what they contain, and how they can be accessed by the worldwide community of scholars."

Data Collection↗
PubMed1997

Development of a cancellous bone structural model by stereolithography for ultrasound characterisation of the calcaneus.

A novel method for the development of a user-defined structural model simulating cancellous bone of the human calcaneus is described using stereolithography (SL). The digital image of a cancellous bone section was modified by skeletonisation and dilation to produce a structural model of uniform wall thickness, determined by the resolution of the stereolithography system. Six SL models were produced using the same data file. The SL models were assessed using the McCue CUBAclinical ultrasound bone densitometer. The broadband ultrasound attenuation (BUA) and velocity (VOS) values obtained were commensurate with the commercial phantom provided with the CUBAclinical system. The intra- and inter-sample variability for the six SL models were similar at 5% for BUA and 2.5% for VOS. Stereolithography offers the potential to firstly, simulate perforation and thinning of cancellous bone associated with osteoporosis, and secondly, to evaluate the dependence of ultrasonic and mechanical parameters upon cancellous bone structure.

Anisotropy↗
PubMed2004

Progressive addition lenses--matching the specific lens to patient needs.

BACKGROUND: The objective of this study was to use state-of-the-art methods to measure the optical characteristics of commonly available progressive addition lenses (PALs) and to develop derivatives of the optical measurements that can be used as guidelines in selection of lenses based on patients' visual needs. METHODS: The optics of 28 PALs currently on the market were measured with a Rotlex Class Plus lens analyzer. PALs were specified with plano distance power and a near add of +2.00 D. Data were normalized to plano at the location specified by each manufacturer and acquired from each data file in 1-mm vertical steps with respect to the fitting cross. RESULTS: The variance across lenses was greater than 2:1 for most measurements. Ratings were calculated based on equal weighting of zone width and area for distance, intermediate, and near zones, and also for magnitude of unwanted astigmatism. CONCLUSIONS: The results demonstrate wide ranges of optical characteristics across the PALs tested in this study. Ratings of the distance, intermediate, and near zones, as well as rating of unwanted astigmatism can be used in selection of appropriate lenses to match patient visual needs.

Eyeglasses↗