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Department of Veterans Affairs, University of Utah consortium participation in the NLM/AHCPR Large Scale Vocabulary Test.

The Large Scale Vocabulary Test (LSVT) was designed to evaluate how well the Metathesaurus plus planned additions to Meta covered the documentation needs of clinicians. Our consortium collected 10,538 clinical narratives from patient problem lists recorded at 65 Veterans Hospitals, internal medicine ambulatory care practices, diagnostic history and physical examination data elements from Iliad, and nursing shift notes and emergency transport patient records. The results showed 94% of submitted terms resulted in acceptable matches. 49% of submitted terms were judged to be synonymous with the match terms, 35% were judged to be more specific (usually due to modifiers), 2%, were less specific, and 6% had an associative relationship. In 8% of cases either no match was found by the LSVT interface or all proposed matches were rejected by the raters. The LSVT content was quite suitable for coding our narratives. Necessary improvements for an electronic record would include the ability to compose modifiers together with root concepts.

Ambulatory Care↗

Major abdominal complications following cardiac transplantation. Utah Transplantation Affiliated Hospitals Cardiac Transplant Program.

Serious complications involving the alimentary tract are commonly reported following cardiac transplantation, and may be associated with significant morbidity and mortality. The aim of this report was to review the incidence, severity, and outcome of abdominal complications in our heart transplant population in whom we used corticosteroid-sparing protocols for immunosuppression. From March 1985 through September 1988, 178 patients underwent 185 cardiac transplants. Twenty-six cardiac transplant recipients (15%) sustained 33 major abdominal complications, including gastrointestinal bleeding (n = 8), pancreatitis (n = 8), bowel perforation (n = 6), cholecystitis (n = 4), and miscellaneous other problems (n = 7). Operative therapy was required in 61% of cases. No deaths were caused by the gastrointestinal complications of their operative management. Corticosteroid-sparing immunosuppression may be responsible for the low incidence of abdominal morbidity, and early, aggressive surgical intervention may reduce subsequent mortality.

Adult↗

Joint anatomy, design, and arthroses: insights of the Utah paradigm.

This model of joint design argues 1) that excessive fatigue damage (MDx) in articular cartilage collagen can be the "final cause" of an arthrosis; 2) that known responses of a growing joint's anatomy and geometry, and modeling and maintenance activities, to mechanical loads minimize that cause and thus arthroses; 3) and many biomechanical, biochemical, cell-biologic, genetic and traumatic "first causes" of arthroses could lead to that final cause. The model depends partly on the following facts (marked by a single asterisk) and ideas (marked by a double asterisk). A) During growth a joint's total loads can increase over 20 times without causing an arthrosis, yet in adults an equal loading increase would cause one. B) Fatigue damage (MDx) occurs in joint tissues, larger strains increase it, and minimizing strains reduces it. C) Bone can repair amounts of MDx below an "MDx threshold," but larger amounts can escape repair and accumulate. The model assumes articular cartilage has similar features. D) Bone modeling makes bones strong enough to keep their strains below bone's MDx threshold and minimize MDx. Chondral modeling shapes and sizes joints during growth; that would keep articular cartilage strains below the chondral MDx threshold to minimize chondral MDx and arthroses. Normal chondral modeling nearly stops in adults, which might explain point A above. E) Throughout life maintenance activities preserve optimal physical, chemical and biologic properties of a joint's tissues. To past emphases on the biochemical, genetic, cellular and molecular biologic features of adult joint physiology, this model adds organ-level, tissue-level and vital-biomechanical features of growing joints that invite study and understanding at lower levels of biologic organization.

Animals↗

Lifestyle and blood pressure levels in male twins in Utah.

Healthy male monozygotic (MZ) and dizygotic (DZ) twin pairs (MZ pairs = 77; DZ pairs = 88) were studied to assess the effect of dietary intake, physical activity, physical fitness, body mass index (BMI), sum of the triceps and subscapular skinfold measurements, alcohol and caffeine consumption, and smoking patterns on blood pressure. Data on physical activity, detailed dietary intake, medical history, and demographics were obtained from a questionnaire. A bicycle ergometer was used to estimate level of fitness; other medical information was ascertained from physical examination. After normalizing the study variables, intraclass correlations for BMI and the sum of the triceps and subscapular skinfold measurements were higher in MZ than in DZ twin pairs (BMI: MZ r = 0.76, DZ r = 0.48; skinfolds: MZ r = 0.73, DZ r = 0.28), as were VO2max(MZ r = 0.63, DZ r = 0.25) and post-bike heart rate (MZ r = 0.69, DZ r = 0.19). Both systolic (SBP) and diastolic blood pressure (DBP) had high heritability estimates (SBP = 0.60, and DBP = 0.66). Using factor analysis, four major lifestyle factors were identified and categorized as: 1) dietary intake; 2) a factor heavily weighted by cigarette smoking, alcohol and caffeine consumption; 3) fatness; 4) physical activity and physical fitness. Adjustment for these factors did not alter heritability estimates for either SBP or DBP.

Blood Pressure↗

Tag SNP selection for Finnish individuals based on the CEPH Utah HapMap database.

The pattern and nature of linkage disequilibrium in the human genome is being studied and catalogued as part of the International HapMap Project [:2003 Nature 426:789-796]. A key goal of the HapMap Project is to enable identification of tag single nucleotide polymorphisms (SNPs) that capture a substantial portion of common human genetic variability while requiring only a small fraction of SNPs to be genotyped [International HapMap Consortium, 2005: Nature 437:1299-1320]. In the current study, we examined the effectiveness of using the CEU HapMap database to select tag SNPs for a Finnish sample. We selected SNPs in a 17.9-Mb region of chromosome 14 based on pairwise linkage disequilibrium (r(2)) estimates from the HapMap CEU sample, and genotyped 956 of these SNPs in 1,425 Finnish individuals. An excess of SNPs showed significantly different allele frequencies between the HapMap CEU and the Finnish samples, consistent with population-specific differences. However, we observed strong correlations between the two samples for estimates of allele frequencies, r(2) values, and haplotype frequencies. Our results demonstrate that the HapMap CEU samples provide an adequate basis for tag SNP selection in Finnish individuals, without the need to create a map specifically for the Finnish population, and suggest that the four-population HapMap data will provide useful information for tag SNP selection beyond the specific populations from which they were sampled.

Chromosome Mapping↗

Gamma-ray spectrometry of humans at the University of Utah.

A human total-body counter was designed and built with two 20 X 10 cm NaI (Tl) crystals suspended over an "isoresponse surface" upon which the subject reclines. This surface is curved from head to knee and from left to right, so that a gamma-ray emitting object is detected with equal efficiency when placed anywhere upon it. The positioner and detectors are housed in a low background enclosure constructed of steel 31 cm thick with a graded inner lining of lead + cadmium + copper. Calibration of the system was accomplished by administering trace amounts of various radionuclides to 48 human subjects of various sizes, ranging in age from 4--80 years. Counting rates per retained muCi at 0.53, 0.66, 1.53, and 2.75 MeV (83Rb, 137Cs, 42K, and 24Na) were determined as a function of body size and were compared with counting rates per muCi of corresponding emitters centered in a polyethylene cylinder of radius 10.3 cm. Limits of detection, corresponding to three times the standard deviation of a 50 min background, were 170 nCi 90Sr (via Bremsstrahlung X-rays), 0.78 nCi 131I, 0.48 nCi 83Rb, 0.52 nCi 137 Cs, 4.9 nCi 40K (or 5.8 g of natural potassium) and 1.7 nCi 222Rn.

Body Height↗