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PubMed2005

Efficacy of computer-aided dosing of warfarin among patients in a rehabilitation hospital.

OBJECTIVE: To determine whether computer-aided dosing of warfarin is superior to physician dosing to maintain a patient in a rehabilitation hospital within a target international normalized ratio goal. DESIGN: Randomized, double-blinded, clinical trial in an inpatient rehabilitation hospital. A total of 30 consecutive patients admitted receiving warfarin were randomized to either clinician dosing or computer-aided warfarin dosing for the duration of their hospitalization. The main outcome measures included the percentage of days in a therapeutic anticoagulation range and the number of blood draws. Exclusion criteria included short length of stay (n=110, 39%) and a physician declared international normalized ratio target range of <2.0 (n=67, 23%). A total of 73 patients were excluded because of heme-positive stools at admission, recent gastrointestinal bleed, early discharge or consent refusal. Dawn AC software was used to determine warfarin dosage and frequency of blood draws to maintain a target international normalized ratio of 2.0-3.0 for the computer-dosed group (n=14). Several physicians recommended warfarin dosages for the second group (n=16). Two were dropped from the computer model secondary to lost data files for these two patients. RESULTS: Computer-aided dosing of warfarin resulted in 61.7% of days within the therapeutic range (international normalized ratio, 2-3), whereas clinician dosing resulted in only 44.1%. There were no significant differences in the number of blood draws or demographic variables between the two groups. CONCLUSION: Computers were significantly better at maintaining patients within a therapeutic international normalized ratio range than physicians. There were no significant differences in the number of recommended blood draws.

Aged↗
PubMed2003

Relationship between age and lower extremity fractures in frontal motor vehicle collisions.

BACKGROUND: Older adults (aged > or = 65 years) represent the single fastest growing segment of the United States population and will comprise one in five Americans during the third decade of this century. As this population segment rapidly expands, lower extremity fractures (LE Fx) and their associated disability will become a greater public health concern. The purpose of this study was to quantify the risk for LE Fx from motor vehicle collisions (MVCs) according to age. METHODS: The 1995 to 2000 National Automotive Sampling System data files were used. Study entry was limited to front-seat occupants involved in frontal MVCs. Risk ratios for LE Fx and age were adjusted for gender, driver versus passenger, seat belt use, airbag deployment, delta-V, intrusion, and vehicle type. RESULTS: Beginning in the fourth decade, there was a trend of higher relative risk for LE Fx with age that reached statistical significance in the seventh decade of life. CONCLUSION: This study documented an increased risk of LE Fx in older MVC occupants. Efforts to prevent these disabling injuries and to better protect occupants' lower extremities in MVCs should include improved vehicle design and reevaluation of the existing federal motor vehicle safety standards.

Accidents, Traffic↗
PubMed2003

Efficacy of hypertonic saline dextran fluid resuscitation for patients with hypotension from penetrating trauma.

BACKGROUND: The purpose of this study was to assess whether the administration of hypertonic saline dextran (HSD) was detrimental when administered to patients who were hypotensive because of penetrating injuries to the torso. The administration of HSD causes an immediate and sustained increase in blood pressure that could contribute to an increase in bleeding in the presence of uncontrolled hemorrhage. We prospectively designed a series of questions to be addressed by a meta-analysis of individual patient data using a computerized data file and case report forms from a multicenter study of HSD. METHODS: The investigators were "blind" as to the treatment the patient received. Patients (n = 230) with penetrating injuries to the torso were studied as to survival until discharge. The patients were administered 250 mL of HSD or normal saline (standard of care [SOC]) as the initial fluid therapy. RESULTS: Of the 120 patients treated with HSD, 82.5% survived compared with 75.5% for 110 SOC patients (p = 0.19). Sixty-eight percent (n = 157) of these patients required surgery. HSD treatment (n = 84) in this population improved survival, 84.5% compared with 67.1% with SOC (n = 73) (p = 0.01). HSD resulted in an increase in blood pressure and a reduction in hematocrit, with no differences noted in fluid requirements or indices of clotting. CONCLUSION: For patients with penetrating injuries to the torso that result in hypotension, initial fluid resuscitation with HSD is beneficial in improving survival, especially if surgery is subsequently required.

Adult↗
PubMed2003

Occupant- and collision-related risk factors for blunt thoracic aorta injury.

BACKGROUND: Blunt thoracic aortic injury (BAI) is a rare and highly lethal injury. We sought to identify occupant and collision characteristics associated with motor vehicle collision (MVC)-related BAI. METHODS: The 1995 to 2000 National Automotive Sampling System data files were used. The National Automotive Sampling System is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. The risk of BAI was calculated according to specific occupant (e.g., age, seat belt use) and collision (e.g., delta-V [estimated change in velocity], vehicular intrusion) characteristics. The association between BAI and these characteristics was calculated using risk ratios (RRs) and associated 95% confidence intervals (CIs). RESULTS: Specific occupant and collision characteristics demonstrated independent association with BAI. Occupant characteristics included age >or= 60 (RR, 3.6; 95% CI, 2.5-5.2), seat belt use (RR, 0.3; 95% CI, 0.2-0.5), and being a front-seat occupant (RR, 3.1; 95% CI, 1.5-6.3). Frontal and near-side MVCs were associated with an increased risk (RR, 3.1; 95% CI, 1.9-5.1; and RR, 4.3; 95% CI, 2.6-7.2, respectively) relative to other collision types. Collisions with a delta-V >or= 40 km/h (RR, 3.8; 95% CI, 2.6-5.6) or that produce extensive vehicle crush (>or= 40 cm) (RR, 4.1; 95% CI, 2.7-6.3) or intrusion (>or= 15 cm) (RR, 5.0; 95% CI, 3.5-7.3) also increase the risk of BAI. CONCLUSION: The risk factors for BAI identified in this study support generally accepted etiologic mechanisms for this injury.

Accidents, Traffic↗
PubMed2004

Specific occupant and collision characteristics are associated with motor vehicle collision-related blunt cerebrovascular artery injury.

BACKGROUND: Blunt cerebrovascular artery injury (BCI) remains difficult to diagnose but is recognized with increasing frequency after motor vehicle collisions (MVCs). Failure to detect this injury in a timely fashion can be devastating. Criteria that can be used to heighten the suspicion of this injury have been suggested; however, more encompassing screening has been recommended. To address this need, we sought to describe occupant, vehicle, and collision characteristics among MVC occupants who sustained a BCI. METHODS: All cases of BCI identified in the National Automotive Sampling System Crashworthiness Data System, a national probability sample of passenger vehicles involved in police-reported tow-away MVCs, between 1993 and 2001 were selected. Information on occupant (e.g., demographics, seating position, and restraint use), collision (e.g., collision type and severity), and vehicle characteristics were obtained and summarized using descriptive statistics. RESULTS: Nine-hundred forty individuals with BCI were identified in the Crashworthiness Data System data files. Over half were belted (57.4%) and 82.3% had airbag deployment; 16.2% were partially or completely ejected from the vehicle. Head and thoracic injuries were common (44.4% and 40.8%, respectively); 27.8% sustained a cervical spine fracture and 21.0% sustained a soft-tissue injury to the neck. The mean Injury Severity Score was 33.6. The case fatality rate was 44.5%. The majority of BCI occupants were drivers (76.0%). Among belted occupants, the lap/shoulder was the most commonly attributed as the injury source (61.4%). Among unbelted occupants, frequent injury sources included air bags (15.0%), windshield (13.7%), and other interior objects. With respect to collision characteristics, the average change in velocity (Delta V) was 43.3 km/h. The majority of collisions were frontal (76.2%). CONCLUSION: This study indicates that BCI is both a rare and lethal injury typified by specific occupant and collision characteristics. These characteristics provide insight as to the cause of this injury that may aid in the evaluation and management of the blunt trauma patient at risk for BCI.

Accidents, Traffic↗
PubMed2004

Is seat belt use associated with fewer days of lost work after motor vehicle collisions?

BACKGROUND: Seat belt use has consistently been shown to reduce motor vehicle collision (MVC)-related morbidity and mortality. The goal of this study is to determine whether seat belt use is associated with fewer lost workdays among occupants involved in MVCs. METHODS: The 1995 to 2000 National Automotive Sampling System (NASS) data files were used. The NASS is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. Occupants' lost workdays, which are routinely collected as part of an NASS investigation, were compared according to seat belt use. RESULTS: During 1995 to 2000 in the United States, surviving occupants involved in MVCs lost a total of 42.1 million workdays (approximately 7.0 million lost workdays per year; 2.4 lost workdays per person). The overall difference in lost workdays between the belted and unbelted occupants was 1.59 days (1.99 days vs. 3.58 days, respectively; p < 0.001). After adjusting for potentially confounding factors, belted occupants had 1.52 fewer lost workdays compared with unbelted occupants (p < 0.001). This translates to an estimated 7.3 million lost workdays and an associated $566 million in lost wages and $1.25 billion in work-place costs attributable to lack of seat belt use in the United States during 1995 to 2000. CONCLUSION: Lost workdays attributable to MVCs in the United States have sizable financial implications. Furthermore, seat belt use significantly reduces lost time at work and is associated with a significant cost savings. The national impact of unbelted driving on work productivity is dramatic, and further efforts to promote appropriate seat belt use should continue as part of the national safety agenda.

Abbreviated Injury Scale↗
PubMed2006

Identification of expression patterns associated with hemorrhage and resuscitation: integrated approach to data analysis.

BACKGROUND: Although transcriptional profiling is a well-established technique, its application to systematic studying of various biological phenomena is still limited because of problems with high-volume data analysis and interpretation. This research project's objective was to create a comprehensive summary of changes in gene expression after hemorrhagic shock (HS), reliant and impartial of multiple variables, such as resuscitation treatments, organ analyzed, and time after impact. METHODS: Rat model of severe (40% total blood loss) HS was employed. Hemorrhagic shock was treated with 6 different resuscitation strategies: (1) racemic lactated Ringer's (DL-LR); (2) L-lactated Ringer's (L-LR); (3) ketone Ringer's (KR); (4) pyruvate Ringer's (PR); (5) 6% hetastarch (Hex); (6) 7.5% hypertonic saline (HTS). Nonresuscitated and nonhemorrhaged rats served as controls. Ketone and pyruvate Ringer solutions were identical to the lactated Ringer's solution except for equimolar substitution of lactate with beta-hydroxybutyrate and sodium pyruvate, respectively. Total RNA from liver, lung, and spleen was isolated immediately (0 hour) and 24 hour postresuscitation. Each organ, time point and treatment was profiled using individual cDNA array (1,200 genes), to produce 183 separate data files. Methods of analysis included one-way and unbalanced factorial ANOVA, Sokal-Michener average linkage clustering and contextual mapping. RESULTS: : Unresuscitated HS produced the highest number (56) of upregulated expressions in spleen and lungs. HEX and HTS affected mostly pulmonary genes (22 and 9). Fourteen genes changed in response to combination of all three factors: treatment, organ, and time. Eighteen genes were identified as treatment-specific. Fifteen genes adjusted expression 24 hour post-treatment. The largest number of genes with altered expression (168) responded differently in all three organs. In this study 15 gene clusters were pinpointed. Contextual mapping identified novel and confirmed known pathways contributing to hemorrhage/resuscitation. CONCLUSIONS: We have reliably identified genes and pathways that are affected by HS and are responsive to resuscitation. Gene expression in various organs is affected differentially by HS, which can be further modulated by the choice of resuscitation strategy.

Analysis of Variance↗
PubMed1999

Surrogates for finding unstable periodic orbits in noisy data sets.

Recently, searches for unstable periodic orbits in biological and medical applications have become of interest. The motivations for this research range, in order of ascending complexity, from efforts to understand the dynamics of simple sensory neurons, through speculations regarding neural coding, to the hopeful development of new diagnostic and/or control techniques for cardiac and epileptic pathologies. Biological and medical data are, however, noisy and nonstationary. Findings of unstable periodic orbits in such data thus require convincing assessments of their statistical significance. Such tests are accomplished by comparison with surrogate data files designed to test an appropriate null hypothesis. In this paper we test surrogates generated by three different algorithms against correlated noise as well as stable periodic orbits. One of the surrogates is new, and has been specifically designed to preserve the shape of the attractor. We discuss the suitability of these surrogates and argue that the simple shuffled one correctly tests the appropriate null hypothesis.

Journal Article↗
PubMed2001

Extracting dynamical structure from unstable periodic orbits.

The topological recurrence algorithm provides a fast and robust method for detecting the presence of unstable periodic orbits (UPO's) in short, noisy experimental data files. We present here a technique for improving this method by using a matrix fitting algorithm to extract dynamical information about the system from these UPO's. This method greatly increases the sensitivity of the algorithm, and also provides a method for identifying false positive results.

Journal Article↗
PubMed2005

FPC Web tools for rice, maize, and distribution.

Many clone-based physical maps have been built with the FingerPrinted Contig (FPC) software, which is written in C and runs locally for fast and flexible analysis. If the maps were viewable only from FPC, they would not be as useful to the whole community since FPC must be installed on the user machine and the database downloaded. Hence, we have created a set of Web tools so users can easily view the FPC data and perform salient queries with standard browsers. This set includes the following four programs: WebFPC, a view of the contigs; WebChrom, the location of the contigs and genetic markers along the chromosome; WebBSS, locating user-supplied sequence on the map; and WebFCmp, comparing fingerprints. For additional FPC support, we have developed an FPC module for BioPerl and an FPC browser using the Generic Model Organism Project (GMOD) genome browser (GBrowse), where the FPC BioPerl module generates the data files for input into GBrowse. This provides an alternative to the WebChrom/WebFPC view. These tools are available to download along with documentation. The tools have been implemented for both the rice (Oryza sativa) and maize (Zea mays) FPC maps, which both contain the locations of clones, markers, genetic markers, and sequenced clone (along with links to sites that contain additional information).

Chromosomes, Plant↗
PubMed1994

The CCP4 suite: programs for protein crystallography.

The CCP4 (Collaborative Computational Project, number 4) program suite is a collection of programs and associated data and subroutine libraries which can be used for macromolecular structure determination by X-ray crystallography. The suite is designed to be flexible, allowing users a number of methods of achieving their aims and so there may be more than one program to cover each function. The programs are written mainly in standard Fortran77. They are from a wide variety of sources but are connected by standard data file formats. The package has been ported to all the major platforms under both Unix and VMS. The suite is distributed by anonymous ftp from Daresbury Laboratory and is widely used throughout the world.

Journal Article↗
PubMed2003

SAXSANA: an interactive program for the analysis and monitoring of static and time-resolved small-angle X-ray solution scattering measurements.

An interactive analytical program, SAXSANA, for small-angle X-ray scattering measurements of solutions is described. The program processes scattered data without disciplined knowledge of small-angle scattering. SAXSANA also assists in finding the best experimental conditions, thus avoiding blind runs of experiments. SAXSANA consists of the following procedures: (i) determination of the centre of scattered X-rays and moment transfer Q (Q = 4pisintheta/lambda, where 2theta is the scattering angle and lambda is the wavelength) for each measured channel; (ii) conversion of the data format to the format of Q versus scattered intensities J(Q); (iii) truncation of unnecessary data and smoothing of scattering curves by cubic-spline function; (iv) correction of the absorption effect and subtraction of the scattered intensity of the buffer (solvent) solution from that of the sample solution; (v) creation of a data file for a three-dimensional representation of time-resolved scattering curves; (vi) determination of radii of gyration by Guinier plots; (vii) determination of persistent lengths by Kratky plots; (viii) extrapolation of the small-angle part by Guinier plots; (ix) extrapolation of the wide-angle part by Porod's & Luzzati's laws for the Hankel transformation in order to obtain the distance distribution function p(r); (x) calculation of p(r) and computation of the invariant, the chord length, the Volume, the spherical radius, the maximum dimension D(max) and the radius of gyration (Rg). SAXSANA also serves as an on-site monitor for the validity of an experimental result during the measurements.

Journal Article↗
PubMed2004

Moderated histogram equalization, an automatic means of enhancing the contrast in digital light micrographs reversibly.

A means for improving the contrast in the images produced from digital light micrographs is described that requires no intervention by the experimenter: zero-order, scaling, tonally independent, moderated histogram equalization. It is based upon histogram equalization, which often results in digital light micrographs that contain regions that appear to be saturated, negatively biased or very grainy. Here a non-decreasing monotonic function is introduced into the process, which moderates the changes in contrast that are generated. This method is highly effective for all three of the main types of contrast found in digital light micrography: bright objects viewed against a dark background, e.g. fluorescence and dark-ground or dark-field image data sets; bright and dark objects sets against a grey background, e.g. image data sets collected with phase or Nomarski differential interference contrast optics; and darker objects set against a light background, e.g. views of absorbing specimens. Moreover, it is demonstrated that there is a single fixed moderating function, whose actions are independent of the number of elements of image data, which works well with all types of digital light micrographs, including multimodal or multidimensional image data sets. The use of this fixed function is very robust as the appearance of the final image is not altered discernibly when it is applied repeatedly to an image data set. Consequently, moderated histogram equalization can be applied to digital light micrographs as a push-button solution, thereby eliminating biases that those undertaking the processing might have introduced during manual processing. Finally, moderated histogram equalization yields a mapping function and so, through the use of look-up tables, indexes or palettes, the information present in the original data file can be preserved while an image with the improved contrast is displayed on the monitor screen.

Actins↗
PubMed2004

Rising trends in cesarean section rates in Egypt.

BACKGROUND: Cesarean section rates have been increasing worldwide, but little research exists on trends of cesarean section delivery for any country in the Arab world. The purpose of this study was to document recent levels and trends of cesarean section rates in Egypt, and to estimate trends in cesarean section by type of hospital from three population-based national surveys. METHODS: This descriptive study used merged data files from three nationally representative samples of ever-married women aged 15 to 49 years. RESULTS: A significant rise in cesarean deliveries occurred for all births, from a low of 4.6 percent in 1992 to 10.3 percent in 2000. However, hospital-based cesarean deliveries were much higher in 1987-1988 (13.9%), increasing to 22.0 percent in 1999-2000. Although the cesarean section rate was slightly higher in private hospitals, the rate also increased consistently in public hospitals. CONCLUSIONS: The high and unprecedented increase in cesarean section rates reported in this study may be partly due to cesarean sections that are not medically indicated, and suggest that physician practice patterns, financial incentives or other profitability factors, and patient preferences should be explored.

Adult↗
PubMed1993

Prognostic significance of selected lifestyle factors in urinary bladder cancer.

To examine the prognostic significance of lifestyle factors in urinary bladder cancer, we conducted a follow-up study of 258 incident bladder cancer patients, who were originally recruited in a case-control study in metropolitan Nagoya. Information on individual survivals was obtained from the computer data-file of the tumor registry of the Nagoya Bladder Cancer Research Group. Univariate analyses revealed significant associations of 5-year survivorship with educational attainment, marital status, drinking habits and consumption of green tea in males, and age at first consultation, histological type and grade of tumor, stage and distant metastasis in both sexes. After adjustment for age, stage, histology (histological type and grade) and distant metastasis by means of a proportional hazards model, drinking of alcoholic beverages was significantly associated with the prognosis of bladder cancer in males. Its adjusted hazard ratio was 0.46 (95% confidence interval: 0.26-0.79), favoring patients who had taken alcoholic beverages. In detailed analysis, ex-drinkers and all levels of current drinkers demonstrated hazard ratios smaller than unity, although no clear dose-response relationship was detected. No prognostic significance was found for such lifestyle factors as smoking habit, uses of artificial sweeteners and hairdye, and consumption of coffee, black tea, matcha (powdered green tea) and cola.

Adult↗
PubMed2004

Iodopropynylbutyl carbamate 0.2% is suggested for patch testing of patients with eczema possibly related to preservatives.

BACKGROUND: Iodopropynyl butylcarbamate (IPBC) is a new preservative in medical and cosmetic leave-on products. Although cases of allergic contact dermatitis to IPBC have been reported, it is not known whether the usual test concentration of 0.1% is appropriate for screening tests with IPBC. OBJECTIVES: To determine the concentration of IPBC that should be used in screening patch tests. METHODS: An analysis was made of data filed by 26 centres of dermatology on patch tests performed with one or two concentrations of IPBC (0.1%, 0.2%, 0.3% or 0.5%) in 8106 unselected patients. Criteria used to determine the best test concentration of IPBC were the reaction index, the positivity ratio, the rate of crescendo reactions, and the relations between IPBC reactions and the MOAHLFA index irritant reactions to sodium lauryl sulphate (SLS), and allergic reactions to other contact allergens including preservatives. RESULTS: IPBC 0.1%, 0.2%, 0.3% and 0.5% yielded 0.5%, 0.8%, 1.3% and 1.7% positive reactions, but this increase was accompanied by an even greater increase in doubtful and irritant reactions. These figures and the other criteria examined suggested the range of suitable test concentrations of IPBC to lie between 0.2% and 0.3%. A detailed analysis of MOAHLFA indices and of associations between reactions to IPBC and reactions to other allergens and to SLS showed that most of the positive reactions to IPBC 0.2% can be assumed to be allergic ones and that with IPBC 0.2% fewer false-positive reactions can be expected than with IPBC 0.3%. CONCLUSIONS: Patch testing with IPBC 0.2% is suggested for patients with eczema possibly related to preservatives.

Adult↗
PubMed2006

Mexican women in California: differentials in maternal morbidity between foreign and US-born populations.

In the US, the majority of deaths and serious complications of pregnancy occur during childbirth and are largely preventable. We conducted a population-based study to assess disparities in maternal health between Mexican-born and Mexican-American women residing in California and to evaluate the extent to which immigrants have better outcomes. Mothers in these two populations deliver 40% of infants in the state. We compared maternal mortality ratios and maternal morbidities during labour and delivery in the two populations using linked 1996-98 hospital discharge and birth certificate data files. For maternal morbidities, we calculated frequencies and observed and adjusted odds (OR) ratios using pre-existing maternal health, sociodemographic characteristics and quality of health care as covariates. Approximately 19% of Mexican-born women suffered a maternal disorder compared with 21% of Mexican-American women (Observed OR = 0.89, [95% CI 0.88, 0.90]). Despite their lower education and relative poverty, Mexican-born women still experienced a lower odds of any maternal morbidity than Mexican-American women, after adjusting for covariates (OR = 0.92, [95% CI 0.90, 0.93]). These findings suggest a paradox of more favourable outcomes among Mexican immigrants similar to that found with birth outcomes. Nevertheless, the positive aggregate outcome of Mexican-born women did not extend to maternal mortality, nor to certain conditions associated with suboptimal intrapartum obstetric care.

Adolescent↗
PubMed1988

Cardiac arrest during anaesthesia. A computer-aided study in 250,543 anaesthetics.

With the aid of a computer-based anaesthetic record-keeping system, all cardiac arrests during anaesthesia at the Karolinska Hospital between July 1967 and December 1984 were retrieved. There were a total of 170 cardiac arrests and 250,543 anaesthetics in the data file, which gives an incidence of 6.8 cardiac arrests per 10,000 anaesthetics. Sixty patients died, constituting a mortality of 2.4 per 10,000 anaesthetics: 42 were considered as inevitable deaths (rupture of aortic or cerebral aneurysm, multitrauma, etc.); 13 cases of cardiac arrest were considered as non-anaesthetic, i.e. complications due to surgery and other procedures. Nine of these patients died. 115 cases of cardiac arrest were considered as caused by the anaesthetic and nine of these patients died. Thus mortality caused by anaesthesia was 0.3 per 10,000 anaesthetics. The most common cause of cardiac arrest due to anaesthesia was hypoxia because of ventilatory problems (27 patients), postsuccinylcholine asystole (23 patients) and post-induction hypotension (14 patients). The highest mortality was seen when spinal or epidural anaesthetics were given to patients with impaired physical status including hypovolaemia. The incidence of cardiac arrest has declined considerably during the period studied, and this coincides with an increasing number of qualified anaesthetists employed in the department during the same period.

Aged↗