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Probabilistic linkage of large public health data files.

Probabilistic linkage technology makes it feasible and efficient to link large public health databases in a statistically justifiable manner. The problem addressed by the methodology is that of matching two files of individual data under conditions of uncertainty. Each field is subject to error which is measured by the probability that the field agrees given a record pair matches (called the m probability) and probabilities of chance agreement of its value states (called the u probability). Fellegi and Sunter pioneered record linkage theory. Advances in methodology include use of an EM algorithm for parameter estimation, optimization of matches by means of a linear sum assignment program, and more recently, a probability model that addresses both m and u probabilities for all value states of a field. This provides a means for obtaining greater precision from non-uniformly distributed fields, without the theoretical complications arising from frequency-based matching alone. The model includes an iterative parameter estimation procedure that is more robust than pre-match estimation techniques. The methodology was originally developed and tested by the author at the U.S. Census Bureau for census undercount estimation. The more recent advances and a new generalized software system were tested and validated by linking highway crashes to Emergency Medical Service (EMS) reports and to hospital admission records for the National Highway Traffic Safety Administration (NHTSA).

Adult↗

Quantitative structure-activity relationships by neural networks and inductive logic programming. II. The inhibition of dihydrofolate reductase by triazines.

One of the largest available data sets for developing a quantitative structure-activity relationship (QSAR)--the inhibition of dihydrofolate reductase (DHFR) by 2,4-diamino-6,6-dimethyl-5-phenyl-dihydrotriazine derivatives--has been used for a sixfold cross-validation trial of neural networks, inductive logic programming (ILP) and linear regression. No statistically significant difference was found between the predictive capabilities of the methods. However, the representation of molecules by attributes, which is integral to the ILP approach, provides understandable rules about drug-receptor interactions.

Animals↗

Normal visual fields measured with Octopus Program G1. I. Differential light sensitivity at individual test locations.

Exact knowledge of the normal variation of visual fields and the influence of age upon them is essential to differentiate normal from abnormal results, e.g., in glaucoma suspects. This study evaluates the normal variability of differential light sensitivity at individual test locations and incorporates a data base of a multicenter study performed with Octopus 201 perimeters using Program G1. The 824 fields thus obtained included 139 fields of 139 healthy volunteers who had undergone two previous visual fields and completed all three phases of the program. Sensitivity decreased linearly with age, an effect which for individual test locations ranged between 0.036 and 0.107 dB/year and which became more pronounced towards the periphery. On average, the age-related effects explained only 17% of the interindividual variation (range 4%-31%). The interindividual variation within a test averaged 4.6 dB2 and revealed a moderate, but quadratic increase towards the periphery. The intra-individual short-term variation was considerably lower, averaging 2.2 dB2. There was a similar modest, quadratic increase of the intra-individual variation towards the periphery. The results may help distinguish incipient disease manifestations from normal variation of perimetric results. Furthermore, the results give insight into the calculation of global visual field indices.

Adult↗

Opioid activities of human beta-casomorphins.

Opioid activities of human beta-casomorphin-4, -5, -7 and -8 and, for comparison, of the corresponding bovine beta-casomorphins were studied in the guinea-pig ileum preparation. Binding parameters, i.e. KD-values and binding site concentrations, for the interaction of human and bovine beta-casomorphins with opioid receptors in rat brain homogenates were determined in inhibition experiments, using [3H]-(D-Ala2, MePhe4, Gly-ol5)enkephalin, [3H]-(D-Ala2, D-Leu5)enkephalin and [3H]ethylketazocin as mu-, delta- and kappa-opioid receptor ligands. Analysis of binding data was performed using a non-linear curve fitting program. All beta-casomorphins examined displayed opioid activity. The affinity was highest for mu-receptors, less so for delta-receptors and lowest for kappa-receptors. It is suggested that human beta-casomorphins might play a role as "food hormones".

Animals↗

Determinants of psychiatric rehospitalization: a social area analysis.

The purpose of this paper is to develop an analytic framework and methodology for estimating the demand for psychiatric hospitalization in state facilities, either new admissions or readmissions of clients from the Community Services Boards (CSBs) of Virginia. The combination of community and organizational factors with inpatient characteristics for the CSBs can help identify pertinent predictors of psychiatric hospitalization. Review of the literature on psychiatric epidemiology shows that the predictors of psychiatric hospitalization can be classified into four major dimensions including community resources, socio-demographic factors, CSB client characteristics, and CSB organizational factors. It is postulated that the rates of first admissions and readmissions to state facilities are influenced by four dimensions. Furthermore, the variation in readmissions rates is contingent upon previous first admission rates and the average length of stays in state institutions while other conditions-such as community resources and demographics, CSB client mix, and CSB organizational factors-are simultaneously considered. The data were compiled from multiple sources. A path analytic model, using a linear structural relations program (LISREL VI), was validated. After the model was carefully fitted, the estimation equations for the rates of first admissions and readmissions were finalized. The estimates for psychiatric hospitalization, both first- and re-admissions, were made for each of the study CSBs.

Health Services Accessibility↗

Analysis of inorganic mercury species associated with airborne particulate matter/aerosols: method development.

This paper describes a method for speciation of Hg associated with airborne particulate matter. This method uses a mini-sampler for sample collection and analysis, thermal desorption for separating Hg species, and inductively coupled plasma mass spectrometry (ICP-MS) for identification and quantification of Hg. Coal fly ash spiked with different Hg compounds (e.g. Hg0, HgCl2, HgO, and HgS) was used for qualitative calibration. A standard reference material with a certified value for Hg concentration was used to evaluate the method. When the temperature of the furnace was programmed at a linear rate of increase of 50 degrees min(-1), different Hg compounds could clearly be separated. Three airborne particulate matter samples were collected in parallel in Toronto, ON, Canada and analyzed using this method. Reproducible results were obtained and Hg0, HgCl2, HgO, and HgS species from these samples were detected.

Journal Article↗

Globoside with spin-labelled fatty acid: bilayer lateral distribution and immune recognition.

We have critically addressed the question of lateral distribution of glycolipids in bilayer membranes, and the effect of glycolipid fatty acid chain length upon such distribution. For this purpose we synthesised the complex neutral glycosphingolipid, globoside, with spin-labelled fatty acid. Base hydrolysis to remove the natural fatty acid was found to deacetylate the GalNAc residue concomitantly, necessitating application of the synthetic route described for gangliosides by Neuenhofer et al. (Biochemistry 24, 525-532 (1985)). Globosides were produced with 18-carbon and 24-carbon fatty acids bearing a spin label at the C-16 position. Spin-labelled globosides were incorporated at 2 and 10 mol% into rigid, highly cooperative bilayer matrices of 1,2-dipalmitoylglycerophosphocholine (DPPC) and also into semi-fluid, non-cooperative membranes of DPPC/cholesterol. Recorded electron paramagnetic resonance (EPR) spectra were analysed by comparison with a library of standards representing samples of known composition. Spectra were manipulated using a computer program which permitted linear combination of standards to stimulate coexistence of laterally separated domains of different composition. The most important conclusions were as follows: (1) at least 80% of the globoside was definitely not confined to domains highly enriched in glycolipid, although there was evidence of binary-phase separation in the rigid DPPC/globoside matrix; (2) the presence of 33 mol% cholesterol reduced the evidence of globoside phase separation; (3) there was remarkably little difference in results whether the globoside fatty acid chain length was similar to that of the phospholipid host matrix or eight carbons longer. Temperature profiles derived over the phase-transition region of DPPC using spin-labelled globoside or an unattached amphiphilic spin label were consistent with these findings. The same systems lent themselves to consideration of the role of glycolipid fatty acid chan length and cholesterol in determining glycolipid crypticity in membranes: (1) polyclonal anti-globoside IgG bound to globoside in DPPC liposomes without inducing agglutination. (2) The same antibodies did agglutinate DPPC/cholesterol liposomes bearing globoside. (3) The effect of cholesterol probably was upon glycolipid dynamics or attitude in the membrane, rather than upon distribution. (4) These observations were basically unaffected by the choice of 18-carbon vs. 24-carbon glycolipid fatty acids.(ABSTRACT TRUNCATED AT 400 WORDS)

1,2-Dipalmitoylphosphatidylcholine↗

Authentic standards for the reductive-cleavage method. The positional isomers of partially methylated and acetylated or benzoylated 1,5-anhydro-D-galactitol.

Described herein is an efficient method for the synthesis of the sixteen positional isomers of methylated and acetylated or benzoylated 1,5-anhydro-D-galactitol. The compounds are generated simultaneously by partial methylation of 1,5-anhydro-D-galactitol and subsequent benzoylation, and the individual isomers are obtained in pure form by high-performance liquid chromatography. Debenzoylation and acetylation yielded the desired acetates. Reported herein are the 1H NMR spectra of the benzoates and the electron-ionization mass spectra of the acetates and the tetra-O-methyl derivative. Also reported for the acetates and the tetra-O-methyl derivative are their linear temperature-programmed gas-liquid chromatography retention indices on three different capillary columns.

Acetylation↗

Authentic standards for the reductive-cleavage method. The positional isomers of partially methylated and acetylated or benzoylated 1,5-anhydro-D-mannitol.

Described herein is an efficient method for the synthesis of the sixteen positional isomers of methylated and acetylated or benzoylated 1,5-anhydro-D-mannitol. The compounds are generated simultaneously by partial methylation of 1,5-anhydro-D-mannitol and subsequent benzoylation, and the individual isomers are obtained in pure form by high-performance liquid chromatography. Debenzoylation of the latter and acetylation yielded the desired acetates. The the benzoates and the electron-ionization mass spectra of the acetates and the tetra-O-methyl derivative are reported herein as are the linear temperature-programmed gas-liquid chromatography retention indices of the acetates and the tetra-O-methyl derivative on three different capillary columns.

Acetates↗

A rapid, flexible method for biochemical assays using a microtiter plate reader and a microcomputer. Application for assays of protein, Na,K-ATPase and K-p-nitrophenylphosphatase.

A computerized system which greatly accelerates and eases the collection, storage, and analysis of data has been applied to several standard biochemical assays. The system uses a commercially available microtiter plate reader connected to an Apple IIe microcomputer via a standard serial port. Data are transmitted automatically from the reader to the microcomputer, where they can be viewed, printed, further analyzed immediately, or stored on a diskette for later retrieval and processing. Some or all of the data may be entered manually. The program calculates a linear least squares best fit to a standard curve after correcting all data for blanks, then determines the quantities of substrate or product contained in each well of a microtiter plate. Data from two plates may be combined, enabling calculation of enzyme specific activities. This system can be adapted to any assay whose final step can be performed by a microtiter plate reader. Its use is described for determination of protein concentration, Na,K-ATPase activity, and K-stimulated p-nitrophenylphosphatase activity.

4-Nitrophenylphosphatase↗

Computer-assisted determination of protein concentrations from dye-binding and bicinchoninic acid protein assays performed in microtiter plates.

The bicinchoninic acid protein assay was scaled down to operate in the wells of microtiter plates. The total volume of the assay was reduced to 210 microliters and required only 10 microliters of sample per assay. The assay can be rapidly performed and then read with a plate reader. The analysis of the data was performed with a microcomputer interfaced with the reader. A computer program was developed to analyze the data from the bicinchoninic acid assay as well as the dye-binding assay at either the high or low protein concentration ranges. Based upon the absorbance values of the standards, the program computed a linear regression formula which was then used to calculate the concentrations of the sample proteins. A series of assays performed using bovine serum albumin, alpha-chymotrypsin and gamma globulin demonstrated that the scaled down bicinchoninic acid assay produced linear absorption versus concentration data with average correlation coefficients between 0.9967 and 0.9940 at the high and low concentration ranges respectively. The protein-to-protein variation and proper selection of either protein assay based upon the presence of interfering materials was considered.

Adult↗

A disaggregation model of a flexible nurse scheduling support system.

A nurse scheduling support system is developed in which the demand profile and nurses' preferences are input to an expert-like capability designed to formulate linear and/or goal programming representations of the problem. Solutions of the alternative optimization models of this decision support system are then evaluated. An assignment model for disaggregating the optimum work patterns of individual nurses based on their desires and compatibilities is discussed in detail. A brief overview of one of the scheduling models and its extension is also presented along with discussion of the various uses of the assignment model.

Hospitals, Urban↗

Trends in cancer mortality in Kanawha County, West Virginia, 1950-1984.

There has been much concern recently about possible adverse health effects related to exposure to toxic chemicals among residents of Kanawha County in southern West Virginia. An epidemiological study of trends in cancer mortality from 1950-1984 among the general population of Kanawha County in southern West Virginia was mounted. Cabell County, West Virginia was chosen to be a comparison county for Kanawha in addition to West Virginia and the total United States. The cancer mortality rates for white males and females were calculated using NCHS mortality data and Census Bureau population data available on the Mortality and Population Data System (MPDS) at the University of Pittsburgh. Mortality rates for cancer in Kanawha and Cabell Counties were evaluated over the time period 1950-1984 with an age-period-cohort (APC) analysis. In this analysis, poisson regression models were fit using the statistical program GLIM (Generalized Linear Models) to determine the separate effects of age, period of death, and birth cohort on the specific cancers of interest (lung, liver, bladder, CNS, leukemia, lympho-reticulosarcoma, all cancers). There were no significant county differences for cancer death rates between Kanawha and Cabell Counties except for leukemia among white males [O.R. = 1.27, 95% (C.I. = 1.03-1.6)], and for lympho-reticulosarcoma [O.R. = 1.66(1.24-2.07)], suggesting a possible occupational exposure. For leukemia, aleukemia, the effect observed seems to have declined. In contrast, the elevation of lympho-reticulosarcoma rates has remained in recent years (1970-1984).

Adolescent↗

Characterization of GTP-gamma-S binding to isolated human platelet plasma membranes and its relationship with the stimulation of a phospholipase C activity.

Binding parameters for the interaction of GTP-gamma-[35S] with isolated platelet plasma membranes have been studied. Analysis of the data by a non-linear curve fitting program indicates that the interaction can be satisfactory described by a model with a single, high affinity binding site (Kd = 0.3 +/- 0.07 microM and Bm = 0.4 +/- 0.2 nmoles of GTP-gamma-S/mg of membrane protein). Binding is selectively inhibited by GDP-beta-S and GMP-PNP (1 microM), but not affected by ATP, CTP, ITP, or UTP, even at mM concentration. Optimal conditions for the interaction were 30 degrees C and pH 8.0. Incubation of the isolated membranes with GTP-gamma-S results in a measurable phospholipase C activity (as detected both by a breakdown of phosphoinositides and an increase of inositide phosphates) which under our experimental conditions is only slightly enhanced by addition of cytosolic proteins. Our results indicate that platelet plasma membranes contain all the necessary elements for signal transduction through the diacylglycerol/inositolphosphates pathway.

Blood Platelets↗

A hybrid FLEET model for emergency medical service system design.

Covering models have been used to locate emergency services such as ambulance and fire protection systems. As an example, in the late seventies, an analysis of the Baltimore, Maryland fire protection system was conducted with the development and use of a covering model called the Facility Location and Equipment Emplacement Technique (FLEET). The FLEET model combined the location of fire stations with the allocation of primary and special service equipment to the stations. Further, in a recent study of Austin, Texas the ambulance system was restructured based on the use of a covering model. Covering models have also been extended to handle some of the special circumstances involved in emergency service systems. One example is the maximal expected coverage problem (MEXCLP). This paper presents a new covering model which utilizes both the special coverage structure of the MEXCLP and the simultaneous station location and equipment allocation of the FLEET model. Optimal solutions are found using linear and integer programming. Results of the model applied to several planning data sets (including a form of the Austin, Texas planning problem) demonstrate that more concentrated ambulance allocation patterns exist which may lead to easier dispatching, reduced facility costs, and better crew load balancing with little or no loss of service coverage. Tradeoff curves are presented which show that significant reductions in the number of dispatching sites (keeping the number of ambulances constant) can be made without any major changes in service level.

Ambulances↗

Half-life of rat angiotensinogen: influence of nephrectomy and lipopolysaccharide stimulation.

The in vivo half-life of two differently glycosylated subforms of rat angiotensinogen (Ao), Ao-1 and Ao-2, was studied in native and nephrectomized rats, as well as in rats treated with lipopolysaccharides (LPS). The metabolic clearance rate of both 125I-labeled derivatives fits a two-compartment model using a non-linear curve fitting program (SCTFIT). Both forms show an initial rapid phase with a half-life of about 1 h. This clearance rate was not altered by either nephrectomy or LPS administration. In the intact rat the two forms were eliminated with a second slower phase half-life of 8.07 h (Ao-1) and 4.53 h (Ao-2), respectively. Following nephrectomy, in the absence of renin, the slower phase of clearance of both forms decreased (t1/2 Ao-1:9.77 h; t1/2 Ao-2: 10.50 h). Induction of low renin concentrations by LPS administration decreased the half-life of the more highly glycosylated form Ao-1 (t1/2: 6.93 h), while that of Ao-2 increased (t1/2: 5.07 h). Inactive angiotensinogen, des-AngI-Ao, of both forms demonstrated a faster metabolic clearance rate in native rats than that of the intact glycoproteins (t1/2 Ao-1: 5.68 h; t1/2 Ao-2: 3.97 h). Based on the plasma levels of these two angiotensinogen subtypes in normal rats, these data suggest a higher secretion rate by the liver for the more highly glycosylated form Ao-1 and a slower clearance rate by the kidney. In contrast, the less glycosylated form shows more rapid elimination by the kidney. Following nephrectomy both glycoproteins are secreted and eliminated in an equimolar ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensinogen↗

Assurance of high quality linac-based stereotactic radiosurgery.

PURPOSE: Stereotactic radiosurgery is generally a single, high-dose radiation treatment for the brain requiring targeting accuracy on the order of a millimeter. From the initial implementation of radiosurgery, therefore, quality assurance is an ongoing process of paramount importance. In this paper, we outline the basic elements of a quality assurance program for our linear accelerator that has been in use at Washington University Medical Center over the past 2 years. METHODS AND MATERIALS: Various devices and procedures have been developed to verify the accuracy and safety of the stereotactic radiosurgery regimen. Specifically, we present methods for assessing the attainment of spatially correct patient images, the reliability of the computerized treatment planning system, achieving physical safety for the patient, as well as the proper operation of the radiation treatment device. RESULTS: Our procedures have allowed us to assure quality patient treatments and, additionally, has permitted monitoring our performance for continual improvement. For example, a plot of targeting accuracy with the number of patients shows an asymptotic approach to a value within 0.6 mm of that ideally expected. CONCLUSION: To maintain high-quality patient care, one must review critical aspects of the treatment regimen on a periodic basis. Providing for the appropriate level of staff training, periodic reviews of procedures and maintenance of forms are also very important.

Humans↗

LAT (lidocaine-adrenaline-tetracaine) versus TAC (tetracaine-adrenaline-cocaine) for topical anesthesia in face and scalp lacerations.

The study objective was to compare the topical anesthetic LAT (4% lidocaine, 1:2,000 adrenaline, 1% tetracaine) to TAC (0.5% tetracaine, 1:2,000 adrenaline, 11.8% cocaine) for efficacy, adverse effects, and costs. The study design was a randomized, prospective, double blind clinical trial set in an inner-city emergency department with an emergency medicine residency program. Adults with linear lacerations of the face or scalp were eligible for inclusion in the study. Patients had lacerations anesthetized with topical TAC or LAT according to a random numbers table. A total of 95 patients were included in the study with 47 receiving TAC and 48 receiving LAT. Patients stated the number of sutures causing pain and patients and physicians rated the overall pain of suturing using a standard visual analog scale (VAS). The power of the study to determine a ranked sum difference of 15 was 0.8. Visual analog scale results and number and percentage of sutures causing pain were compared using Wilcoxon's Rank Sum Test. According to patients, the percentage of sutures causing pain was significantly fewer for LAT than TAC (P = .036, Interquartile Range 0.13 to 0.0 for LAT, 0.25 to 0 for TAC). Physicians found LAT statistically more effective than TAC (P = .0093, Interquartile Range 1 to 0 for LAT, 2 to 0 for TAC) but patients did not report a difference (P = .266, Interquartile Range 1 to 0 for both LAT and TAC). Our cost per application was $3.00 for LAT compared to $35.00 for TAC. Follow-up was accomplished in 91 of 95 patients (95%) with no reported complications for either medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗