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PubMed1989

QUAD: a computer package for the analysis of QUantal Assay Data.

The computer package QUAD has been developed at the University of Kent, U.K. It is menu driven and written in Advanced BASIC. It runs on IBM PC compatible machines equipped with a suitable graphics facility such as CGA or simulated CGA. QUAD is available on a floppy disk, for a small handling charge. QUAD has four main functions: it performs a logit analysis of quantal assay data; it provides a flexible way of analysing the data, allowing dose transformations and providing alternative confidence intervals for EDp values; it produces a range of diagnostics for assessing the fit of models to data; it provides and fits two families of extended models, each containing the logit as a special case. The package makes use of the latest statistical research, and fitted models are displayed by means of the good graphics facilities available on microcomputers. This document describes the facilities available in detail, and provides and discusses, illustrations of the package at work. QUAD has been designed as a pilot package. Further additions and developments are planned and described later.

Animals↗
PubMedDate not supplied

Choosing from the health care reform menu.

Rising costs and diminished insurance coverage have reduced support for the U.S. health care system among all stakeholders. Proposals for reform have arrayed policymakers along discrete lines, with some favoring incremental reform, others endorsing an expanded role for employers, and still others pushing for a radical conversion to a publicly-financed, publicly-administered program. Each carries enough negatives to make it difficult, if not impossible, to achieve. Rather than waiting for a consensus on one or the other, the U.S. can adopt a strategy that would extend insurance coverage without fueling inflation. All Americans would be guaranteed coverage via a mandate on employers, an expanded public program, and creation of powerful quasi-governmental financial agents who would negotiate and set prices paid to providers.

Cost Control↗
PubMed1982

Factors affecting riboflavin requirements of oral contraceptive users and nonusers.

Riboflavin depletion has been identified in women on oral contraceptives (OC) but change in riboflavin nutriture has not been consistently demonstrated in all OC user groups studied. Discrepant findings in reports have been attributed to differences of pill formulation or riboflavin intake. Aims of this study were to compare the riboflavin requirements of healthy OC users and nonusers on diets prepared in a metabolic unit. A single daily menu and meal pattern was used. The basic diet providing riboflavin at a level of 0.6 mg/1000 kcal was used in the period of acclimation and period 1. In periods 2 and 3, the riboflavin content of the diet was increased to 0.8 and 1.0 mg/1000 kcal, respectively. The riboflavin status of subjects was monitored by erythrocyte glutathione reductase assay and urinary riboflavin excretion. Eight women on OC and 10 nonusers participated. Erythrocyte glutathione reductase assay values and urinary riboflavin excretion showed intersubject and interperiod differences but no significant group differences (OC versus non-OC) in erythrocyte glutathione reductase values or in urinary riboflavin per g creatinine. It was concluded that when dietary intake is controlled, OC do not significantly influence riboflavin status. Riboflavin needs were related to energy requirements of the subjects.

Adult↗
PubMed2003

[Imaging pelvic floor prolapse].

OBJECTIVES: Dynamic MR imaging (MRI) may be used as an alternative to dynamic cystoproctography for the evaluation of pelvic floor prolapse. Our study aimed to define the range of dynamic pelvic MRI aspects observed during the exploration of pelvic prolapse. MATERIAL: Fascial and anatomic defects can include a combinaison of cystocele, rectocele, uterine prolapse, enterocele and vault prolapse. Acute diagnosis of the coexisting abnormalities is essential in planning reconstructive procedures so that the risks of recurrence and reoperation can be minimized. At this time colpocystography is the study of choice to evaluate pelvic floor dysfunction. Dynamic magnetic resonance imaging for exploration of pelvic floor dysfunction is under evaluation. RESULTS: Pubococcygeal line and puborectalis muscle were the references points. The grading system is based on degree of organ prolapse through the hiatus and the degree of pubo-rectalis descent and hiatal enlargement. Unfortunately, there is a real discordance between the reality of the prolapse and its imaging. However, a new reference line, the mid pubic line, was drawn on the magnetic resonance image to correspond to the hymeneal ring marker used in clinical staging. Intra-operative findings were considered the gold standard against which physical examination, dynamic colpocystodefecography and MRI were compared. Using these criteria the sensitivity, specificity and positive predictive value of MRI were 70%, 100%, 100% for cystocele; 42%, 81%, 60% for vaginal vault or uterine prolapse; 100%, 83%, 75% for enterocele; 87%, 72% and 66% for rectocele. CONCLUSION: MRI appears to be an important adjunct in the comprehensive evaluation of the female pelvis. Except for vaginal vault, pelvic prolapse is accurately staged and pelvic organ prolapse reliably detected. The technique is rapid, non invasive and cost effective, it allows the clinician to visualize the whole pelvis using a single dynamic study that provides anatomical details.

Adult↗
PubMed1994

A prospective study of adolescents who choose among levonorgestrel implant (Norplant), medroxyprogesterone acetate (Depo-Provera), or the combined oral contraceptive pill as contraception.

OBJECTIVES: Levonorgestrel implants (Norplant) and medroxyprogesterone acetate injections (Depo-Provera) represent additional contraception options for adolescents. The purpose of this study was to examine prospectively clinical profiles among adolescents who chose one of the two long-term contraceptives compared with profiles among those who chose the combined oral contraceptive pill (OCP). METHODS: Girls who needed contraception and did not require confidentiality were presented with a contraceptive menu consisting of Norplant (n = 58), Depo-Provera (n = 66), or OCP (n = 75). At baseline and follow-up visits over 6 months, patients were interviewed regarding gynecologic history, side effect symptoms, and satisfaction. The average age of subjects was 15.5 years (range 11 to 20 years); 66% were African-American and 34% white. RESULTS: Significantly more teens who chose Depo-Provera (73%) reported having used some method of birth control previously than those selecting either Norplant (30%) or OCP (26%). Adolescents who chose either Norplant (34%) or Depo-Provera (43%) were significantly more likely to have been pregnant previously than those choosing OCP (12%). Those selecting Depo-Provera were significantly more likely to report a history of genital infection with Chlamydia trachomatis (42%) than those in the other two contraceptive groups (22%). Prevalences of reported recent depression and fatigue before initiation of treatment were high, exceeding 35% across the three groups. A total of 105 and 40 adolescents were assessed at 3 and 6 months, respectively. At follow-up, more than 80% of OCP users maintained regular menstrual cycles, whereas over 80% of those choosing Norplant or Depo-Provera had disrupted cycles. Complaints of nausea and dizziness among Norplant users and fatigue among Depo-Provera and OCP users increased significantly between the baseline and follow-up visits. Reports of local reactions to the Norplant device were common but not clinically significant. Blood pressure readings, facial acne, and body mass index did not change over time in any treatment group. Subjects in the Norplant and Depo-Provera groups appreciated freedom from daily compliance to maintain contraceptive effectiveness and the "hidden" nature of the method. Appointment compliance at the end of 6 months was 78% for Depo-Provera, 40% for Norplant, and 46% for OCP. CONCLUSIONS: The implant and injection forms of contraception appear to be especially popular among girls with previous pregnancies or birth control use. The common occurrences of medical symptoms and sexually transmitted diseases before initiation of therapy underscore the importance of baseline evaluation. Norplant users may be warned about nausea and dizziness as well as minor local symptoms around the insertion site and unpredictable uterine bleeding patterns. Adolescent patients choosing Depo-Provera may expect amenorrhea by the end of 6 months of therapy along with possible fatigue. Early intervention may be needed with adolescents who choose Norplant or OCP to encourage better compliance with follow-up appointments.

Adolescent↗