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PubMed2025

Predicting Weight Loss After Vertical Sleeve Gastrectomy Using a Whole-genome Sequencing-derived Polygenic Risk Score in the All of Us Cohort.

OBJECTIVE: To create a genome-wide polygenic risk score (PRS) to improve prediction of a 12-month percentage weight loss (WL) after vertical sleeve gastrectomy (VSG). BACKGROUND: Variability in post-VSG WL is not well explained by clinical factors. The All of Us program provides access to a 414,830 short-read whole-genome sequencing resource, enabling unbiased discovery of genetic predictors after VSG. METHODS: VSG counts, demographic, anthropomorphic and vital sign information were obtained from the linked electronic health record. The discovery cohort (DC) included participants from version 7 carried into version 8 while the validation cohort (VC) included those newly added to v8. We defined good responders and nonresponders as having WL±1SD from the mean. Following quality filtering, we applied a 2-stage penalized-regression, followed by elastic-net logistic regression, to identify 1583 stable variants and derive β-weights. We then tested this PRS on the DC into a prediction model. RESULTS: We identified 395 participants in the DC and 336 participants in the VC, respectively. Of these, VSG, 44 were classified as good responders (≥37% WL) and 55 as nonresponders (≤19% WL). In the VC, 55 were classified as good responders and 48 as nonresponders. Adding the PRS to models to clinical predictors increased the area under the curve following logistic regression by 0.03; P <4.3 × 10 -14 , random forest by 0.03; P <9.1 × 10 -7 , decision tree by 0.05; P = 1.2 × 10 -3 , and gradient boosting by 0.08; P <8.3 × 10 -10 . CONCLUSIONS: Use of short-read whole-genome sequencing from All of Us (AoU) can be effectively used to generate PRS to enhance predictive WL accuracy. This work has implications for outcomes of both bariatric surgery and other surgical procedures.

Humans↗

PubMed2005

Utilization and costs for children who have special health care needs and are enrolled in a hospital-based comprehensive primary care clinic.

OBJECTIVE: When deciding how much hospital resources should be allocated to comprehensive primary care clinics for children with multisystem disorders, it is important to consider all of the non-primary care revenue streams associated with these children as well as the effects of a comprehensive primary care program on access and quality. The objectives of this study were, first, to determine costs as well as the payments associated with hospital ambulatory and inpatient services for children with multisystem disorders followed by a comprehensive primary care clinic; and, second, to determine the effect of enrollment in a hospital-based comprehensive primary care clinic on ambulatory and inpatient utilization patterns and expenditures for children with multisystem disorders. METHODS: The study population for the payment analysis consisted of 1012 children of all ages who were seen in the Special Primary Care Clinic (SPCC) in 2001. For these children, outcomes included direct costs, total (direct plus allocated overhead) costs, and payments per patient per 365 days after their first SPCC visit in 2001. A total of 175 of these patients were 4 years of age or older and had no SPCC visit before their first visit in 2001. We compared utilization and expenditures for the 175 children during the year before enrollment in SPCC with those in the year after enrollment. The Children's Hospital administrative database was used to document direct costs, total costs, and payments by type of service for 365 days after an index visit. Ambulatory services included medical and surgical ambulatory, inpatient, emergency department (ED), and ancillary services. We determined the proportion of children who had visits; the visit rates per 100 child-years; and the average total and direct costs per visit, per child with a visit, and per child-year. Inpatient services data included non-intensive care and intensive care hospitalization rates per 100 child-years; the proportion of children hospitalized; their average length of stay; and the average total and direct costs per hospitalization, per patient hospitalized, and per child-year of total patients in the cohort. RESULTS: For 1012 children who were seen in SPCC in 2001, the hospital overall loss per child-year was $956. The loss per child-year for outpatient services was $1554. This loss was partially offset by a gain from inpatient services of $598. For the 175 patients for whom data were available to compare costs before and after enrollment in the SPCC, there were no significant differences in hospitalization or in direct costs per patient for patients who were hospitalized. The average length of non-intensive care stay was lower after enrollment (4.8 vs 11.7). In the surgical specialty analysis, children were more likely to see a surgeon after enrollment (41% vs 21%) and had a higher rate of visits per 100 child-years (102.3 vs 51.4). Differences in medical subspecialty, ancillary, and ED services did not achieve statistical significance. CONCLUSION: This study suggests that children with multisystem disorders are medically fragile and require frequent hospitalizations and ED visits even with improved primary care. Enrollment in a comprehensive primary care program was associated with a decreased length of stay for non-intensive care hospitalizations and with increased use of surgical services.

Adolescent↗

PubMed1981

Selected prognostic variables for mammographic parenchymal patterns.

Conjecture exists about the influence of numerous risk-factors for breast cancer on mammographic parenchymal patterns. To allow more precise documentation of the common variables considered influential in alterations of breast parenchyma, we conducted a randomized retrospective analysis. Of 10,132 women participants in the Louisville Breast Cancer Detection Demonstration Project, every tenth participant was randomly selected for evaluation using SPSS statistical programming. Each accessioned patient had discriminant analysis for the risk factors of age, parity, age at birth of first child, family history, personal history, previous history of breast biopsy, and exogenous estrogen therapy. One-thousand-and-two women were examined for the significance of the selected prognostic variable association with Wolfe mammographic parenchymal patterns (WMPP). Each prognostic factor was tested by chi-square analysis for the low-risk pattern (N1P1) versus the high-risk pattern (P2DY). A high correlation existed between the age of patient and WMPP (P = 0.0002) in the subjects evaluated (50--85 years, mean 60). Similarly, a very significant correlation was evident between WMPP and parity (P = 0.0002), age at birth of first child (P = 0.0014), family history of breast cancer (P = 0.097), and history of previous breast biopsy (P = 0.0066). Little correlation existed between the Wolfe parenchymal pattern classification and a personal history of breast cancer (P = 0.7779) or the use of exogenous estrogens (P = 0.5776).

Age Factors↗

PubMed2003

Profile of on-line anatomy information resources: design and instructional implications.

This study is based on a review of 40 on-line anatomy web resources compiled from sites selected from our own searches as well as sites reviewed and published by an external group (Voiglio et al., 1999, Surg. Radiol. Anat. 21:65-68; Frasca et al., 2000, Surg. Radiol. Anat. 22:107-110). The purpose of our survey was to propose criteria by which anatomy educators could judge the characteristics of the currently available web-based resources for incorporation into the courses they teach. Each site was reviewed and scored based on a survey matrix that included four main categories: 1). site background information, 2). content components, 3). interactivity features, and 4). user interface design components. The average score of the reviewed sites was 3.3 of the total possible score of 10, indicating the limited use of computer-based design features by the majority of sites. We found, however, a number of programs in each of the survey categories that could serve as prototypes for designing future on-line anatomy resources. From the survey we conclude that various design features are less important than the comprehensiveness, depth, and logical organization of content. We suggest that the content should be sufficient for supporting explicitly defined educational objectives, which should target specific end-user populations. The majority of anatomy programs currently accessible on-line fall short of these requirements. There is a need for a coordinated and synergistic effort to generate a comprehensive anatomical information resource that is of sufficient quality and depth to support higher levels of learning beyond the memorization of structure names. Such a resource is a prerequisite for meaningful on-line anatomy education.

Anatomy↗

PubMed1984

Regional coordinators of continuing pharmacy education. Seven years later.

In 1976 a regional network of coordinators of continuing education was established in British Columbia to increase the accessibility of programs to all pharmacists. The purpose of this paper is to report the contributions of the network to continuing education since its inauguration. As of 1983, 94 pharmacists have been trained to assist with the design and management of continuing education programs and they have had a significant impact on regional programming. When yearly summary statistics from the four years prior to the network are compared to the seven subsequent years an approximate five-fold increase in the average number of programs is found. There is also a greater than two fold increase in the average number of contact hours and an approximate six-fold increase in the average number of registrations. The network of coordinators has increased not only the quantity but also the relevancy of programs by focusing on regional needs. In addition, the network has had spill-over benefits to the University of British Columbia and the licensing body in some of their other province-wide activities such as teleconferencing competency assessment, and poison prevention programs.

Administrative Personnel↗

PubMed2003

Childhood cancer patients' access to cooperative group cancer programs: a population-based study.

BACKGROUND: The Children's Oncology Group (COG), a merger of the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG), conducts clinical trials for the treatment of childhood cancer. To assess the feasibility of developing a nationwide childhood cancer registry, the authors attempted to determine whether COG could serve as a resource for identifying all children with cancer. METHODS: A consolidated file of children age < 20 years who were diagnosed with cancer between 1992-1997 and registered with either CCG or POG was linked with records from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Age-specific registration rates and age-adjusted registration rates (AARR) were calculated overall and by year of diagnosis, gender, race/ethnicity, stage of disease at diagnosis, and type of cancer. RESULTS: Of 10,108 children age < 20 years with cancer who were identified by the 11 SEER registries between 1992-1997, 5796 were registered with CCG or POG. The AARR was 71% for children age < 15 years, 24% for adolescents ages 15-19 years, and 57% for children age < 20 years. Registration rates were stable over the years studied, varied by geographic region, and were found to be higher among children with more advanced disease. Registration rates were highest for children with leukemia, hepatic tumors, and renal tumors, and were lowest for carcinoma and retinoblastoma. CONCLUSIONS: The results of the current study demonstrate that not all children with cancer are registered by the cooperative groups; however, a national registry program can be achieved by supplementing cases identified through COG with data collected by statewide population-based cancer registries. Such a partnership would be mutually beneficial, allowing COG to achieve 100% registration of children with cancer and, for the statewide cancer registries, improving the timeliness of case-finding and follow-up information for cancer outcomes.

Child↗

PubMed2004

Quantitative analysis of interconnectivity of porous biodegradable scaffolds with micro-computed tomography.

Pore interconnectivity within scaffolds is an important parameter influencing cell migration and tissue ingrowth needed to promote tissue regeneration. Methods for assessment of interconnectivity are usually qualitative, restricted to two-dimensional images, or are destructive. Microcomputed tomography nondestructively provides three-dimensional (3D) images of intact specimens at high spatial resolutions. We describe an image analysis technique for quantitative assessment of scaffold interconnectivity. Scaffolds were made via a particulate leaching process with 75%, 80%, 85%, and 88% volumetric porogen fractions. Specimens were scanned and resulting 3D, digital images were analyzed with a custom algorithm. A series of virtual, idealized scaffolds were also created for illustration of the algorithm's analysis approach and for its validation. The program calculated accessible void fractions over a range of minimum connection sizes. In real specimens, nearly 100% of the porous volume was connected with outside air for connections greater than or equal to 20 microm in their smallest dimension. In scaffolds made with 75% porogen, the accessible void fraction decreased to 78% if only those connections greater than or equal to 260 microm were considered. The relationship between accessible void fraction and connection size varied as a function of porogen content. The interconnectivity parameter described here may have implications for cell migration and tissue growth into scaffolds.

Algorithms↗

PubMed1986

Implementation of an advanced clinical and administrative hospital information system.

Over the last six years since University Hospital opened, the University Hospital Information System (UHIS) has continued to evolve to what is today an advanced administrative and clinical information system. At University Hospital UHIS is the way of conducting business. A wide range of patient care applications are operational including Patient Registration, ADT for Inpatient/Outpatient/Emergency Room visits, Advanced Order Entry/Result Reporting, Medical Records, Lab Automated Data Acquisition/Quality Control, Pharmacy, Radiology, Dietary, Respiratory Therapy, ECG, EEG, Cardiology, Physical/Occupational Therapy and Nursing. These systems and numerous financial systems have been installed in a highly tuned, efficient computer system. All applications are real-time, on-line, and data base oriented. Each system is provided with multiple data security levels, forward file recovery, and dynamic transaction backout of in-flight tasks. Sensitive medical information is safeguarded by job function passwords, identification codes, need-to-know master screens and terminal keylocks. University Hospital has an IBM 3083 CPU with five 3380 disk drives, four dual density tape drives, and a 3705 network controller. The network of 300 terminals and 100 printers is connected to the computer center by an RF broadband cable. The software is configured around the IBM/MVS operating system using CICS as the telecommunication monitor, IMS as the data base management system and PCS/ADS as the application enabling tool. The most extensive clinical system added to UHIS is the Physiological Monitoring/Patient Data Management System with serves 92 critical care beds. In keeping with the Hospital's philosophy of integrated computing, the PMS/PDMS with its network of minicomputers was linked to the UHIS system. In a pilot program, remote access to UHIS through the IBM personal computer has been implemented in several physician offices in the local community, further extending the communications horizons of University Hospital's Information System. The implications of remote access to PDMS through the IBM PC emulating a Siemens Model 420 Patient Data Management Terminal are being examined.

Artificial Intelligence↗

PubMed1995

Schizophrenia and the life cycle.

We reframe the longitudinal treatment of persons with schizophrenia from the perspective of phases in adult development. This approach articulates the need for different interventions of varying intensities over the person's lifetime. The paper discusses the implications of an adult developmental perspective in managing pharmacologic treatment and psychosocial interventions, and in reallocating financial resources for improved long-term outcomes. This perspective is especially useful in the context of a comprehensive community mental health program permitting access to a continuum of services throughout the lifecycle.

Adolescent↗

PubMed2005

Home blood glucose prediction: clinical feasibility and validation in islet cell transplantation candidates.

AIMS/HYPOTHESIS: Diabetic subjects do home monitoring to substantiate their success (or failure) in meeting blood glucose targets set by their providers. To succeed, patients require decision support, which, until now, has not included knowledge of future blood glucose levels or of hypoglycaemia. To remedy this, we devised a glucose prediction engine. This study validates its predictions. METHODS: The prediction engine is a computer program that accesses a central database in which daily records of self-monitored blood glucose data and life-style parameters are stored. New data are captured by an interactive voice response server on-line 24 h a day, 7 days a week. Study subjects included 24 patients with debilitating hypoglycaemia (unawareness), which qualified them for islet cell transplantation. Comparison of each prediction with the actually observed data was done using a Clarke Error Grid (CEG). Patients and providers were blinded as to the predictions. RESULTS: Prior to transplantation, a total of 31,878 blood glucose levels were reported by the study subjects. Some 31,353 blood glucose predictions were made by the engine on a total of 8,733 days-used. Of these, 79.4% were in the clinically acceptable Zones of the CEG. Of 728 observed episodes of hypoglycaemia, 384 were predicted. After transplantation, a total of 45,529 glucose measurements were reported on a total of 12,906 days-used. Some 42,316 glucose predictions were made, of which 97.5% were in the acceptable CEG Zones A and B. Successful transplantation eliminated hypoglycaemia, improved glycaemic control, lowered HbA(1)c and freed 10 of 24 patients from daily insulin therapy. CONCLUSIONS/INTERPRETATION: It is clinically feasible to generate valid predictions of future blood glucose levels. Prediction accuracy is related to glycaemic stability. Risk of hypoglycaemia can be predicted. Such knowledge may be useful in self-management.

Blood Glucose Self-Monitoring↗

PubMed2006

The impact of syringe deregulation on sources of syringes for injection drug users: preliminary findings.

In 2001, New York State enacted legislation to allow the provision of syringes by pharmacies and healthcare providers without prescription (ESAP, the Expanded Syringe Access Demonstration Program). A longitudinal study of IDUs (n=130) found that pre-ESAP, about half used only the safest source (needle exchange programs [NEPs]). Post-ESAP implementation, ESAP sources were initiated by 14%. Frequency of injection was related to ESAP use and those who used unsafe (or possibly unsafe) sources were as likely to use ESAP as those who had previously used only NEPs. The findings indicate that providing multiple sources of safe syringes for IDUs is necessary.

Humans↗

PubMed1991

Coordinating community and public-institutional mental health services: some unintended consequences.

Where a target group such as the mentally ill tend to use multiple and varied services over a long period of time, service coordination is often seen as the key to continuity of care. This article argues that coordination also has its perverse effects. To demonstrate, two types of community organizations (COs) working in mental health in the Canadian province of Québec are examined: alternative COs, which have their roots in community action and maintain few formal links with each other or with institutional resources; and transitional structures, COs which are developed with the cooperation of psychiatric professionals, are closely linked to hospitals and are often part of a tightly coordinated system of community services. With respect to access, continuity, programs, internal structure and flexibility, each type of community resource has particular strengths and weaknesses. In the first part of the article, these are described and compared. In the second part of the article, we examine the possible effects of Québec's new mental health policy on COs working in mental health. The policy seeks to create comprehensive systems coordinating all services at the regional level-including alternative organizations, transitional structures and public institutions. The imperatives of the complex planning process risk diluting or even eradicating the differences between the two types of mental health COs described earlier. The process may thus rob certain service users of the particular advantages they found in alternative COs. For those mentally ill who, by choice or by chance, remain marginal to the coordinated system, there may ultimately be no resources available at all.

Community Mental Health Services↗

PubMed2005

Clinicians' information sources for new substance abuse treatment.

Little is known about clinicians' information sources for new treatments or ways to improve dissemination of that information. We analyzed 163 clinicians' responses to a checklist of where and how frequently they obtain information on new treatment approaches. They reported at least yearly use of a median of four cosmopolite categories (e.g., journals or books, Internet) and a median of three local categories (e.g., co-workers, personal experience) with interpersonal contact with co-workers (89%) and seminars/conferences (86%) being the most frequently endorsed responses for at least yearly use. In response to the hypothetical scenario of receiving monthly e-mail summaries of journal articles, 59% of the clinicians rated the strategy as "very helpful". If continuing education credits were offered, more clinicians (from 50-80%) would read the relevant articles. Information dissemination may improve with expanded Internet access at programs and short e-mailed summaries carrying links to full articles coupled with the incentive of earning continuing education credits.

Books↗

PubMed2006

Sudden cardiac arrest in intercollegiate athletes: detailed analysis and outcomes of resuscitation in nine cases.

BACKGROUND: Public access defibrillation programs have demonstrated a survival benefit in persons with out-of-hospital cardiac arrest. However, little is known about the effectiveness of early defibrillation in young competitive athletes with sudden cardiac arrest (SCA). OBJECTIVES: The purpose of this study was to investigate the details and outcomes of resuscitation in a cohort of intercollegiate athletes with SCA. METHODS: Nine cases of SCA in intercollegiate athletes occurring between 1999 and 2005 were identified through prior research and public media. A detailed questionnaire was completed by the certified athletic trainer involved in the resuscitation, and direct phone follow-up was achieved in every case. RESULTS: Nine intercollegiate athletes with SCA (4 basketball, 2 football, 2 lacrosse, and 1 swimming) had an average age of 21 years (range 18-30 years). All 9 athletes had a witnessed collapse, 7 occurred during practice, 1 during competition, and 1 during organized weight training. Cardiopulmonary resuscitation (CPR) was initiated within 30 seconds after cardiac arrest in 6 cases and by 1 minute in 2 additional cases. An automated external defibrillator (AED) was provided by an athletic trainer in 5 cases and by arriving emergency medical services (EMS) in 4 cases. The initial cardiac rhythm was confirmed or suspected ventricular fibrillation in 7 athletes, pulseless idioventricular rhythm in 1 case, and unknown in 1 case. In 7 cases a shock was deployed, with an average time from cardiac arrest to defibrillation of 3.1 minutes (range 1-7.5 minutes). The average time from arrest to defibrillation decreased significantly if an AED was provided by an athletic trainer as compared with the responding EMS (1.6 vs 5.2 minutes; P = .046). Eight of the 9 athletes died. The underlying cause of sudden cardiac death was hypertrophic cardiomyopathy in 5, commotio cordis in 2, and myocardial infarction in 1. Diagnostic studies in the survivor demonstrated no structural heart disease or precise cause of SCA. CONCLUSION: Despite witnessed collapse, immediate CPR, and prompt AED use in most cases, early defibrillation showed limited success, and survival was less than expected in this small cohort of intercollegiate athletes. More research is needed to determine the effectiveness of early defibrillation and factors that affect survival in young athletes with SCA.

Adolescent↗

PubMed2026

EZH1/2 inhibition selectively targets SMARCA4/2 co-deficient lung cancer cells by suppressing stemness and proliferation.

SMARCA4-deficient thoracic malignancies comprise biologically heterogeneous tumors, ranging from conventional non-small cell lung cancer with SMARCA4 alterations to thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT), an aggressive entity frequently associated with concomitant SMARCA2 loss. However, the extent to which SMARCA4-deficient lung cancer cell lines recapitulate SMARCA4-UT-like biology remains incompletely defined. Here, we characterized lung cancer cell lines across distinct SMARCA4 and SMARCA2 states and identified a subgroup with SMARCA4/2 co-deficiency that exhibited reduced expression of epithelial lineage markers and transcriptional similarity to SMARCA4-UT and other SWI/SNF-deficient malignancies. The EZH1/2 inhibitor HM97662 selectively suppressed growth in SMARCA4/2-deficient cells, with limited effects in SMARCA2-proficient cells. EZH1/2 inhibition broadly reduced H3K27me3 and induced derepression of PRC2 targets regardless of drug sensitivity. However, its biological effects were most pronounced in SMARCA4/2-deficient cells, where it promoted apoptosis, reduced stemness marker expression, attenuated the SMARCA4-UT-associated transcriptional signature, and suppressed proliferative and mTORC1-related programs. Chromatin accessibility analysis further revealed cell-line-specific patterns of accessibility loss, with reduced accessibility at stemness-associated transcription factor motif-enriched regions coupled with transcriptional repression of nearby genes in SMARCA4/2-deficient cells. These findings support dual EZH1/2 inhibition as a potential therapeutic vulnerability in SMARCA4/2-deficient, SMARCA4-UT-like lung cancer cells.

Humans↗

PubMed2004

An assessment of public attitudes toward automated external defibrillators.

OBJECTIVE: We assessed the familiarity of the general public with automated external defibrillators (AEDs) and their willingness to use them. METHODS: Shoppers were asked to complete a survey in an AED-equipped suburban shopping mall. RESULTS: 359 surveys were analyzed. Of the participants, 11% were healthcare professionals, 51% had training in CPR or first aid, and 44% had no medical training. Sixty percent were able to define defibrillator adequately. Seventy-one percent stated they would be likely to use an AED to resuscitate a stranger. The most common concerns were fear of using the machine incorrectly (57%) and fear of legal liability (38%). After being told of liability protection from the federal Cardiac Arrest Survival Act, 84% stated they would be likely to use the AED. This increased further to 91% if the participants were given an opportunity to receive training. CONCLUSION: Although a substantial number of people in this setting were willing to use an AED, education regarding legal liability and proper use of the machines increased the reported likelihood of use. Further public education may be necessary to provide optimally effective public access defibrillation programs.

Adult↗

PubMed1990

Treating adolescents. Legal and ethical considerations.

Treating adolescents in the health care system raises significant legal and ethical issues related to consent for treatment, confidentiality of communications and records, and payment for care. The law provides many opportunities for adolescents to consent to their own care and offers significant protections of confidentiality. Publicly funded programs provide access to free care for some adolescents, but financial considerations continue to limit access for many poor and low-income adolescents. In addition to legal concerns, serious ethical dilemmas arise, particularly with respect to treatment of special populations of adolescents. Resolution of the legal and ethical questions requires cooperation of professionals from many disciplines.

Adolescent↗

PubMed2003

Neonatal hearing screening.

Neonatal hearing screening can be performed using reliable and reproducible methods. Intervention before the age of 6 months with hearing aids and appropriate educational support services will give the infant the best possible opportunity to develop language. Potential barriers to efficient implementation of a neonatal hearing screening program include access to appropriate and timely diagnostic and support services and insurance to cover the services. Without universal neonatal hearing screening, many children with hearing loss will be missed, which will have a direct negative impact on their speech, language, educational, and social development.

Hearing Disorders↗