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Performance evaluation of a model describing the effects of temperature, water activity, pH and lactic acid concentration on the growth of Escherichia coli.

A square root-type model for Escherichia coli growth in response to temperature, water activity, pH and lactic acid was developed by Ross et al. [Int. J. Food Microbiol. (2002).]. Predicted generation times from the model were compared to the literature data using bias and accuracy factors, graphical comparisons and plots of residuals for data obtained from both liquid growth media and foods. The model predicted well for 1025 growth rate estimates reported in the literature after poor quality or unrepresentative data (n=215) was excluded, with a bias factor of 0.92, and an accuracy factor of 1.29. In a detailed comparison to two other predictive modes for E. coli growth, Pathogen Modeling Program (PMP) and Food MicroModel (FMM), the new model generally performed better. The new model consistently gave better predictions than the other models at generation times </=5 h. Inclusion of the lactic acid term in the model is proposed to account for the consistently good performance of the model for comparisons to growth in meat, a parameter that is not explicitly included in the other models considered in the comparisons.

Cell Division↗

Patients with diagnosed diabetes mellitus can be accurately identified in an Indian Health Service patient registration database.

OBJECTIVE: The computerized patient registration databases maintained by the Indian Health Service (IHS) represent a potentially important source of data about the epidemic of diabetes among American Indian and Alaskan Native people. The purpose of this study is to determine the accuracy of this data source, and to identify the optimal search criteria to identify patients with a diagnosis of diabetes in an IHS patient registration database. METHODS: The authors compared the results of a series of computerized searches to a "gold standard" sample of 465 manually reviewed charts from a large IHS facility. RESULTS: Among patients ages 15 years and older, the best criterion for identifying patients diagnosed with diabetes was the presence of at least one purpose of visit narrative identified by a 250.00 to 250.93 ICD-9 code. The presence of a single computerized code for diabetes identified patients with diagnosed diabetes with a sensitivity of 92% (95% confidence interval [CI] 81, 97), a specificity of 99% (95% CI 98, 99), and a calculated positive predictive value of 94% (95% CI 85, 99). In a separate chart review of 462 charts of patients who had at least one 250.00 to 250.93 ICD-9 code recorded in the database, 435 had a diagnosis of diabetes for an observed positive predictive value of 94%. Because the prevalence of diabetes varies by age of the patient, the positive predictive value of the ability to identify patients with diabetes also varies by age. CONCLUSION: A computerized search of an IHS patient database can identify patients with a diagnosis of diabetes with an accuracy that is similar to the reported accuracy from other health care system databases.

Abstracting and Indexing↗

A possible artefactual component in specific cause mortality gradients. Social class variations in the clinical accuracy of death certificates.

This paper investigates one possible avenue of artefactual influence on the production and/or concealment of social class gradients in specific cause mortality rates, namely, the possibility of social class biases in the accuracy of diagnosis of cause of death and the systematic misallocation of certain social groups to particular diagnoses. Information on this topic was obtained by matching occupational data gathered at death registration with data on the accuracy of diagnosis of cause of death (measured by diagnostic agreement between clinician and pathologist) collected in a prospective study of 1152 hospital necropsies. Extrapolation from these data to national mortality rates should be cautious, but it appears that in the majority of the most common causes of death grouped by ICD chapter (neoplasms, cerebrovascular and digestive) social class gradients would be steeper if mortality data were based on pathologists' rather than clinicians' diagnoses. Only in the respiratory chapter would the gradient be reduced, with the gradient in cardiovascular deaths unaffected.

Age Factors↗

A simplified procedure for entry of raw genotypic data.

Genotypic data entry is a time-consuming and tedious task in genetic linkage studies. Success of the study is dependent upon the accuracy of the data. To simplify the process and eliminate data entry errors, we developed procedures that enable scientists to rapidly enter large quantities of data and compare the data entered with those entered by another individual. These procedures significantly reduce the time required to enter data while improving its integrity. The procedure relies on quick association of a single-digit pattern number with the visual image of an animal's genotype. This association is facilitated by a standard set of rules applicable to all possible outcomes (pseudocode provided). Fewer data entry errors are made because the procedure reduces required keystrokes by 75% and short-term memory load. These procedures have been used as independent programs operating in PC environments (programmed in FORTRAN) as well as linked with a relational database on an IBM 9377 [programmed in CSP(AE/AD) and SQL/DS].

Animals↗

Evaluation of alternative equations for prediction of intake for Holstein dairy cows.

Six prediction equations for dry matter intake (DMI) were evaluated for accuracy with independent data. The equations were selected based on ease of parameter measurement and practical on-farm use. The equations were assessed for accuracy of predicting individual weekly DMI for primiparous (n = 105) and multiparous (n = 136) cows; three-fourths of these cows were supplemented with a sustained-release form of bovine somatotropin (bST). Large variations in accuracy were identified across the six prediction equations for effects of parity and bST. Prediction accuracy of all equations for cows in wk 1 to 24 of lactation was better for primiparous cows than for multiparous cows. Precision of prediction equations was poor for cows in wk 8 through 12 of lactation and for cows in > 40 wk of lactation. The equation for DMI with the best accuracy measured by a low total lactation mean square prediction error was the modified equation of the National Research Council: DMI (kilograms per day) = -0.293 + 0.372 x fat-corrected milk (kilograms per day) + 0.0968 x body weight 0.75 (kilograms). However, the overall mean bias (predicted minus observed) of the prediction of weekly DMI of a single cow was high for all equations, including the modified equation of the National Research Council. For wk 2, 4, 8, 10, and 20 of lactation, the mean bias for the modified equation was +6, +3.4, -1.3, -2.1, and -2.8 kg/d. The accuracy of prediction was lower for cows treated biweekly with bST. High yielding cows and cows treated biweekly with bST had higher milk yields in relation to body weight, and standardized prediction equations for DMI were less accurate.

Animal Nutritional Physiological Phenomena↗

[Accuracy evaluation of land vegetative cover index by RS detection].

The accuracy of GIS data is important in GIS application. In this paper, a fictitious case and an example were used to discuss the relationship between accuracy of land vegetative cover index and accuracy of image classification, and this relationship was explained by mathematics. The accuracy of land vegetative cover index rested with the accuracy of image classification, but had no direct relations with total classification accuracy. User accuracy and producer accuracy had more direct control on the accuracy of land vegetative cover index than total classification accuracy; and hence, they could not be ignored in the image classification. To improve the accuracy of land vegetative cover index, user accuracy and producer accuracy of the same land type should be consistent to the greatest extent.

Conservation of Natural Resources↗

[Imaging diagnosis for fatty liver: a systematic review].

OBJECTIVE: To systematically assess imaging diagnostic tests for fatty liver and provide a decision-making basis for clinical diagnosis and screening. METHODS: Electronic searches were conducted on the Chinese Biomedical Database, PubMed, and EMBASE, combining with manually searching of Chinese literature. All searches were completed until November 2002. All studies which evaluated imaging diagnostic test of human fatty liver were included. Data of diagnostic accuracy in the included studies were extracted, and methodological quality of the studies was assessed independently by two reviewers according to the established quality standard. Quantitative analysis or qualitative description were performed based on available data. RESULTS: Of 13 studies that met the eligibility criteria, 10 studies evaluated the diagnostic accuracy of B-mode ultrasound, 3 studies evaluated contrast-enhanced (helical) CT. To assess 7 diagnostic test studies for fatty liver that used liver biopsy as reference test: the pooled sensitivity of B-mode ultrasound was 0.89 (95% confidence interval 0.87-0.92), specificity was 0.94 (95% confidence interval 0.92-0.96) and the Q value was 0.90 by adjusted SROC method. To assess 2 diagnostic test studies for fatty liver that used CT as reference test: the pooled sensitivity, specificity, and Q value were 0.92 (95% confidence interval 0.89-0.96), 0.88 (95% confidence interval 0.84-0.92), and 0.90 respectively by adjusted SROC method. CONCLUSIONS: B-mode ultrasound method can be regarded as an effective method for fatty liver diagnosis and screening. The methodologic quality of diagnostic test needs to be improved.

Fatty Liver↗

Accuracy of case-reported family history of melanoma in Queensland, Australia.

A positive family history is used in clinical practice as an indication of increased melanoma risk, yet there are no data on the accuracy of reported family histories of melanoma. The validity of case-reported family history of melanoma was assessed in the course of a family and twin study of melanoma in Queensland, Australia, conducted among the families of 2,118 melanoma cases diagnosed in Queensland between 1982 and 1990. A total of 913 melanoma cases made 1,267 reports of melanoma among their first-degree relatives. A total of 1,040 of these reports were checked, first through relatives themselves and then, if the relative also said they had had melanoma, through the relative's medical records. Medical confirmation of melanoma as the diagnosis was obtained for 623 reports (59.9%; 95% confidence interval 56.9-62.9): a false-positive reporting rate by cases of 40.1%. The level of false-positive reporting was lower for cases under 70 years of age, for women, for cases whose own diagnosis of melanoma was more than 5 years earlier, and for cases with three or more relatives with melanoma. Media campaigns in Queensland aimed at increasing skin cancer awareness, and confusion between melanoma and other more common actinic neoplasma (basal and squamous cell carcinomas), may partly explain the high false-positive reporting rate observed here. For this reason, It is difficult to generalize these findings to northern hemisphere populations where skin cancer is not such an important public health issue.

Adolescent↗

Waiting time information services: an evaluation of how well clearance time statistics can forecast a patient's wait.

Governments in some countries have created web-based information services so that patients requiring elective surgery can compare the waiting times of surgical units. This study investigated how accurately the waiting times of patients about to join a waiting list can be forecast by various clearance time statistics. It used 3 years of elective surgical activity data that covered 46 surgeons in 10 specialties within a public hospital. Six clearance time functions were tested, and the best function was compared with average waiting time statistics derived from census and throughput data. The forecast accuracy of the clearance time functions was found to be greatly affected by the characteristics and behaviour of a surgeon's waiting list. Although there was less difference in performance among the six functions, systematic differences between them were also found. The best of these performed better than the statistics derived from waiting time data, especially where waiting times exceeded 6 months. Yet, its accuracy was still poor. For each surgeon with an average waiting time of more than 6 months, at least 20% of patients waited more than 90 days beyond the clearance time forecast. Consequently, while waiting time information services should consider adopting the clearance time approach, they need to be explicit about its statistical limitations.

Elective Surgical Procedures↗

World Health Organization international intercalibration study on dioxins and furans in human milk and blood.

Under the sponsorship of the World Health Organization (WHO), an interlaboratory calibration on the analysis of PCDD/PCDFs in human milk and blood was carried out which included 19 laboratories from 14 countries. The study design involved the analysis of three samples of each matrix in triplicate. Selected samples were spiked with native standards of certain 2,3,7,8-substituted congeners at concentrations known only to WHO staff. The study design resulted in approximately 4000 individual pieces of PCDD/PCDF data generated by a variety of analytical methods, at various concentrations, and by laboratories of widely different experience. This was, by considerable margin, the largest study which allowed for the direct comparison of laboratory and method performance. The results of statistical analysis of this data base addresses the effect on data quality of clean up methods, instrumental methods, analyte concentration, laboratory QA programs, and laboratory experience. The study has shown that the laboratory is the single most important determinant of data precision and accuracy. The method of analyte enrichment (sample clean up), analyte measurement [gas chromatography/mass spectrometry (GC/MS) protocol], and analyte concentration have weaker correlations with data quality.

Chromatography, Gas↗

Economic evaluations of HIV treatment and health research with people diagnosed with HIV infection and co-occurring mental health and substance use disorders.

This paper describes the research challenges involved in measuring costs in economic evaluations of patients who are coping simultaneously with HIV/AIDS and co-occurring mental health and substance abuse disorders-especially in multi-site studies. We describe the general issues that arise in measuring costs for this population and suggest some operational solutions for their resolution, drawing from our experience in a recent multi-site health services research study focused on this population. We show that while reliance on patient self-report data may be unavoidable to provide a common denominator in multi-site studies, there are also some practical ways of improving the accuracy of such data and the cost estimates that result from them. We also provide readers with a means for securing the data collection instruments developed for the cost component of this study in the hope that these may serve as templates for researchers doing similar work.

Cost-Benefit Analysis↗

Computerized outcomes analysis for congenital heart disease.

PURPOSE OF REVIEW: This paper reviews the past year's literature on computerized outcomes analysis for congenital heart disease. RECENT FINDINGS: This review focuses on recent advances in four areas of computerized outcomes analysis for congenital heart disease: nomenclature, database, complexity adjustment, and data verification. A common nomenclature, along with a common core minimal dataset, were adopted by the European Association for Cardio-thoracic Surgery and the Society of Thoracic Surgeons and published in 2000 in the Annals of Thoracic Surgery; the thrust towards the establishment of an international nomenclature is now being developed further by the International Society for Nomenclature of Pediatric and Congenital Heart Disease [http://www.IPCCC.net]. This common nomenclature and common minimum database dataset, created by the International Congenital Heart Surgery Nomenclature and Database Project, are now used by the European Association for Cardio-thoracic Surgery and Society of Thoracic Surgeons since 1998, this nomenclature and database have been used to analyze outcomes of over 40 000 patients. Two major multi-institutional efforts have attempted to measure case complexity: the Risk Adjustment in Congenital Heart Surgery-1 and the Aristotle Complexity Score. Collaborative efforts involving the European Association for Cardio-thoracic Surgery and Society of Thoracic Surgeons are underway to develop mechanisms to verify data completeness and accuracy. SUMMARY: Methods of congenital heart disease outcomes analysis continue to evolve, with continued advances in four areas: nomenclature, database, complexity adjustment, and data verification.

Child↗

A systematic review of the literature examining the diagnostic efficacy of measurement of fractionated plasma free metanephrines in the biochemical diagnosis of pheochromocytoma.

BACKGROUND: Fractionated plasma metanephrine measurements are commonly used in biochemical testing in search of pheochromocytoma. METHODS: We aimed to critically appraise the diagnostic efficacy of fractionated plasma free metanephrine measurements in detecting pheochromocytoma. Nine electronic databases, meeting abstracts, and the Science Citation Index were searched and supplemented with previously unpublished data. Methodologic and reporting quality was independently assessed by two endocrinologists using a checklist developed by the Standards for Reporting of Diagnostic Studies Accuracy Group and data were independently abstracted. RESULTS: Limitations in methodologic quality were noted in all studies. In all subjects (including those with genetic predisposition): the sensitivities for detection of pheochromocytoma were 96%-100% (95% CI ranged from 82% to 100%), whereas the specificities were 85%-100% (95% CI ranged from 78% to 100%). Statistical heterogeneity was noted upon pooling positive likelihood ratios when those with predisposition to disease were included (p < 0.001). However, upon pooling the positive or negative likelihood ratios for patients with sporadic pheochromocytoma (n = 191) or those at risk for sporadic pheochromocytoma (n = 718), no statistical heterogeneity was noted (p = 0.4). For sporadic subjects, the pooled positive likelihood ratio was 5.77 (95% CI = 4.90, 6.81) and the pooled negative likelihood ratio was 0.02 (95% CI = 0.01, 0.07). CONCLUSION: Negative plasma fractionated free metanephrine measurements are effective in ruling out pheochromocytoma. However, a positive test result only moderately increases suspicion of disease, particularly when screening for sporadic pheochromocytoma.

Journal Article↗

Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database.

INTRODUCTION: The present paper describes the methods of data collection and validation employed in the Intensive Care National Audit & Research Centre Case Mix Programme (CMP), a national comparative audit of outcome for adult, critical care admissions. The paper also describes the case mix, outcome and activity of the admissions in the Case Mix Programme Database (CMPD). METHODS: The CMP collects data on consecutive admissions to adult, general critical care units in England, Wales and Northern Ireland. Explicit steps are taken to ensure the accuracy of the data, including use of a dataset specification, of initial and refresher training courses, and of local and central validation of submitted data for incomplete, illogical and inconsistent values. Criteria for evaluating clinical databases developed by the Directory of Clinical Databases were applied to the CMPD. The case mix, outcome and activity for all admissions were briefly summarised. RESULTS: The mean quality level achieved by the CMPD for the 10 Directory of Clinical Databases criteria was 3.4 (on a scale of 1 = worst to 4 = best). The CMPD contained validated data on 129,647 admissions to 128 units. The median age was 63 years, and 59% were male. The mean Acute Physiology and Chronic Health Evaluation II score was 16.5. Mortality was 20.3% in the CMP unit and was 30.8% at ultimate discharge from hospital. Nonsurvivors stayed longer in intensive care than did survivors (median 2.0 days versus 1.7 days in the CMP unit) but had a shorter total hospital length of stay (9 days versus 16 days). Results for the CMPD were comparable with results from other published reports of UK critical care admissions. CONCLUSIONS: The CMP uses rigorous methods to ensure data are complete, valid and reliable. The CMP scores well against published criteria for high-quality clinical databases.

Adult↗

In situ combustion measurements of CO, H2O, and temperature with a 1.58-microm diode laser and two-tone frequency modulation.

An optical near-infrared process sensor for electric are furnace pollution control and energy efficiency is proposed. A near-IR tunable diode laser has performed simultaneous in situ measurements of CO (1,577.96 nm), H2O (1,577.8 and 1,578.1 nm), and temperature in the exhaust gas region above a laboratory burner fueled with methane and propane. The applicable range of conditions tested is representative of those found in a commercial electric arc furnace and includes temperatures from 1,250 to 1,750 K, CO concentrations from 0 to 10%, and H20 concentrations from 3 to 27%. Two-tone frequency modulation was used to increase the detection sensitivity. An analysis of the method's accuracy has been conducted with 209 calibration and 105 unique test burner setpoints. Based on the standard deviation of differences between optical predictions and independently measured values, the minimum accuracy of the technique has been estimated as 36 K for temperature, 0.5% for CO, and 3% for H2O for all 105 test data points. This accuracy is sufficient for electric arc furnace control. The sensor's ability to nonintrusively measure CO and temperature in real time will allow for improved process control in this application.

Journal Article↗

Medicare's Cooperative Cardiovascular Project: can we trust our MetaStar report cards? Cardiovascular Care Committee of Wausau Hospital.

The purpose of Medicare's Cooperative Cardiovascular Project (CCP) is to improve the care of Medicare patients presenting with acute myocardial infarction (AMI). MetaStar is Wisconsin's Medicare peer review organization that administers Phase II of the CCP. A major Phase II objective is to increase the use of reperfusion strategies (thrombolysis and angioplasty) and angiotensin converting enzyme (ACE) inhibitors (when the ejection fractions is < 40%) in patients presenting with AMI. After MetaStar presented Wausau Hospital's baseline Phase II data to us, we were asked to define a plan to improve the use of reperfusion therapy and ACE inhibitors. To verify the accuracy of the data presented to us, we reviewed the patient records used by MetaStar to calculate our baseline data for these 2 quality-of-care indicators. Our MetaStar reported reperfusion rate (48.4%) and ACE inhibitor rate (20.9%) were significantly different from that which we calculated (100% and 97%). Causes for the discrepancy included MetaStar abstractor's failure to exclude two patients who did not have an AMI, failure to correctly count patients who received the targeted treatment, and an inability of the abstractors to identify important CCP exclusion criteria. Thus, numerous patients who should have been excluded were inappropriately classified as "ideal" candidates for the targeted therapy. WE CONCLUDE: There are major flaws in the data collection techniques used by MetaStar in Phase II of the CCP. These flaws produced erroneous conclusions concerning our use of reperfusion strategies and ACE inhibitors. Since these quality-of-care indicators are major targeted goals of Phase II, the errors are of special concern. We believe better-designed abstract forms, due diligence, and more thorough training could have prevented the errors. In presenting our concerns, we hope to foster a response by MetaStar to improve the quality of the peer review process.

Angiotensin-Converting Enzyme Inhibitors↗

Determining arterial pressure, left atrial pressure and cardiac output from the left pneumatic drive line of the total artificial heart.

These data presented here demonstrate how careful analysis of mock loop testing can lead to useful measurements for long-term calf experiments. The accuracy of the data rae primarily dependent upon a valid circulatory system analog and good experimental technique. These methods of determining arterial pressure, left atrial pressure and cardiac output have allowed us to obtain recordds of these important parameters for periods as long as 100 days in calves with total artificial heart implantation. These methods have also enabled us to automatically control the artifical heart under conditions of rest, exercise and pharmacologic treatment with the use of only one external pneumatic drive line pressure transducer.

Animals↗

Determination of BAY 12-8039, a new 8-methoxyquinolone, in human body fluids by high-performance liquid chromatography with fluorescence detection using on-column focusing.

A reversed-phase (RP) high-performance liquid chromatographic (HPLC) method with fluorescence detection allowing the sensitive and specific quantification of BAY 12-8039, a new antimicrobially active 8-methoxyquinolone, in biological fluids is described. The method is compared to a microbiological assay (bioassay) based on B. subtilis test strain with a limit of quantification of approximately 60 microg/l. Following dilution and centrifugation, plasma, saliva or urine supernatant is directly injected onto the HPLC system. Concentrations down to a limit of quantification of 2.5 microg/l can be quantified in plasma, saliva and urine. Data on recovery, accuracy and precision of the method throughout the whole working range as well as results on stability of the analyte are presented. The concentration data are correlated with results from the bioassay. BAY 12-8039 is stable in plasma after repeated freeze-thaw cycles and following storage at -20 degrees C for at least 12 months. The results of HPLC measurements excellently agree with bioassay data indicating the relevance of the method as a tool in clinical development to answer pharmacokinetic questions related to antimicrobial activity. The method was applied to human plasma, saliva and urine from subjects after a single oral dose of 400 mg of BAY 12-8039.

Administration, Oral↗