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PubMed2001

Cost segregation of assets offers tax benefits.

A cost-segregation study is an asset-reclassification strategy that accelerates tax-depreciation deductions. By using this strategy, healthcare facility owners can lower their current income-tax liability and increase current cash flow. Simply put, certain real estate is reclassified from long-lived real property to shorter-lived personal property for depreciation purposes. Depreciation deductions for the personal property then can be greatly accelerated, thereby producing greater present-value tax savings. An analysis of costs can be conducted from either detailed construction records, when such records are available, or by using qualified appraisers, architects, or engineers to perform the allocation analysis.

Cost Allocation↗
PubMed2001

[Modified midwife managed unit--an alternative for small birthing departments?].

BACKGROUND: The Norwegian Board of Health has proposed to divide the delivery units into three categories. For several of today's smaller consultant managed units this could lead to a reclassification into midwife managed units. MATERIAL AND METHODS: During 1997 and 1998 the community hospital in Lofoten has tried out a modified type of midwife managed unit. By a continuous selection process a high risk and a low risk group of gravidas were identified. The high risk group was referred to the central hospital in Bodø, while the low risk group was offered to deliver locally. RESULTS: Previously more than 90% delivered at the community hospital in Lofoten, while approximately 70% still delivered locally during the trial period. There were no deliveries during transport and no serious complications for mother or child caused by the new system. The community hospital had facilities for performing emergency caesarean sections. In 1997 nine caesarean sections out of 211 deliveries and in 1998 four out of 224 were performed. The caesarean section rate for the total population was lower during the trial period than over the previous five years. INTERPRETATION: A modified midwife managed unit could be a good alternative for small consultant managed units if the Norwegian Board of Health's proposal is carried through.

Birthing Centers↗
PubMed2001

The impact of molecular biology on clinical neurology.

Advances in molecular biology have increased our understanding of both inherited and sporadic forms of neurological disease. In this review, the impact of these advances is discussed in relation to specific neurological conditions. These include the hereditary neuropathies and ataxias, Huntington's disease, and the muscular dystrophies, as well as Alzheimer's disease, Parkinson's disease, and motor neuron disease. Genetic channelopathies, such as familial hemiplegic migraine, are also described. Although knowledge in this area overall is still relatively scant, current advances in molecular biology have helped in the reclassification of some neurological disorders, thereby providing a further step towards the development of rational therapies to treat these conditions.

Alzheimer Disease↗
PubMedDate not supplied

Development of a classification system for periodontal diseases and conditions.

Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. In addition, such systems give clinicians a way to organize the health care needs of their patients. The last time scientists and clinicians in the field of periodontology and related areas agreed upon a classification system for periodontal diseases was in 1989 at the World Workshop in Clinical Periodontics. Subsequently, a simpler classification was agreed upon at the 1st European Workshop in Periodontology. These classification systems have been widely used by clinicians and research scientists throughout the world. Unfortunately, the 1989 classification had many shortcomings, including: (1) considerable overlap in disease categories, (2) absence of a gingival disease component, (3) inappropriate emphasis on age of onset of disease and rates of progression, and (4) inadequate or unclear classification criteria. The 1993 European classification lacked the detail necessary for adequate characterization of the broad spectrum of periodontal diseases encountered in clinical practice. The need for a revised classification system for periodontal diseases was emphasized during the 1996 World Workshop in Periodontics. In 1997 the American Academy of Periodontology responded to this need and formed a committee to plan and organize an international workshop to revise the classification system for periodontal diseases. The proceedings in this volume are the result of this reclassification effort. The process involved development by the Organizing Committee of an outline for a new classification and identification of individuals to write state-of-the-science reviews for each of the items on the outline. The reviewers were encouraged to depart from the preliminary outline if there were data to support any modifications. On October 30-November 2, 1999, the International Workshop for a Classification of Periodontal Diseases and Conditions was held and a new classification was agreed upon (Figure 1). This paper summarizes how the new classification for periodontal diseases and conditions presented in this volume differs from the classification system developed at the 1989 World Workshop in Clinical Periodontics. In addition, an analysis of the rationale is provided for each of the modifications and changes.

Adolescent↗
PubMed2001

Polyamine distribution profiles in the eighteen genera phylogenetically located within the Flavobacterium-Flexibacter-Cytophaga complex.

Cellular polyamines of eighteen genera belonging to the Flavobacterium-Flexibacter-Cytophaga complex were analysed by ion exchange liquid chromatography. Homospermidine was the major polyamine in the genera Bergeyella, Riemerella, Ornithobacterium, Weeksella, Capnocytophaga, Polaribacter and Psychroflexus belonging to the family Flavobacteriaceae. In the family Spirosomaceae, Runella, Spirosoma and Flectobacillus species contained spermidine whereas Cyclobacterium species contained homospermidine. Within a divergent cluster, Haliscomenobacter and Lewinella species contained spermidine whereas Saprospira grandis contained agmatine alone. The major polyamine of Chitinophaga and Sporocytophaga species was homospermidine. Flexithrix dorotheae contained spermidine. Microscilla marina, the type species of the genus Microscilla, contained spermidine and cadaverine. However, 'Microscilla sericea' contained homospermidine, 'Microscilla furvescens' contained spermidine, and 'Microscilla arenaria' lacked all polyamines. Polyamine profiles serve as a phenotypic chemotaxonomic marker for the reclassification of the genera belonging to the complex.

Bacteria↗
PubMed2001

Trends in human immunodeficiency virus diagnoses among women in the United States, 1994-1998.

OBJECTIVE: Since the introduction of combination antiretroviral therapy in 1996, acquired immune deficiency syndrome (AIDS) data no longer provide information about trends in human immunodeficiency virus (HIV) incidence; therefore, we used HIV surveillance data to describe recent trends in HIV diagnoses among women. METHODS: Using HIV cases reported from 25 states with confidential HIV reporting, we examined new HIV diagnoses from 1994 to 1998 among women born between 1950 and 1979 by five-year birth cohorts. We adjusted for reporting delays and anticipated reclassification of cases reported without exposure risk. RESULTS: During the period, 24 171 cases of HIV infection were diagnosed among women. The annual number increased 4% from 1994 to 1995, then declined 12% from 1995 to 1998. The annual number of diagnoses attributed to heterosexual contact (HC) among women age 15 to 19 in 1994 (born 1975-1979) increased 117% from 1994 to 1998. Among older women, HC-related diagnoses remained stable or declined. The annual number of diagnoses attributed to injection drug use (IDU) among women age 15 to 19 in 1994 increased 90% from 1994 to 1998. The number of IDU-related diagnoses among older women declined between 31% and 59%. Diagnosis rates were higher among HC-related cases than among IDU cases. The rate for IDU-related diagnoses declined by nearly half over the period, but remained stable for HC-related diagnoses. CONCLUSIONS: HIV diagnoses among women decreased slightly between 1994 and 1998. As the youngest cohort of women reached the age where risk behaviors are initiated, however, the number of diagnoses attributed to IDU increased and the number of diagnoses attributed to HC more than doubled. It is in this youngest cohort, where risk behaviors have only recently been initiated, that HIV diagnoses most closely approximate trends in HIV incidence.

Adolescent↗
PubMed2001

The etiology of maternal mortality in developing countries: what do verbal autopsies tell us?

OBJECTIVE: To reassess the practical value of verbal autopsy data, which, in the absence of more definitive information, have been used to describe the causes of maternal mortality and to identify priorities in programmes intended to save women's lives in developing countries. METHODS: We reanalysed verbal autopsy data from a study of 145 maternal deaths that occurred in Guerrero, Querétaro and San Luis Potosí, Mexico, in 1995, taking into account other causes of death and the WHO classification system. The results were also compared with information given on imperfect death certificates. FINDINGS: The reclassification showed wide variations in the attribution of maternal deaths to single specific medical causes. CONCLUSION: The verbal autopsy methodology has inherent limitations as a means of obtaining histories of medical events. At best it may reconfirm the knowledge that mortality among poor women with little access to medical care is higher than that among wealthier women who have better access to such care.

Adult↗
PubMed1998

[Subclinical Sjögren's syndrome].

OBJECTIVE: To investigate various manifestations and treatment of subclinical Sjögren's syndrome (SS). METHODS: A long term clinical, laboratory and sialographic observations were performed in 24 patients with subclinical SS. Injectin of thymosin intramusularly was used to treat the patients and clinical effect of this treatment was evaluated. RESULTS: All of 24 cases had experienced recurrent parotid swellings (RPS) for 2-17 years (mean 7 years) before dry mouth and dry eyes occurred and all of them were misdiagnosed as chronic suppurative parotitis or sialadenitis. Follow-up showed that all of these patients developed SS. Vasculitis was found in 8 cases, purpura in 2 cases. The vascular involvement was relatively common in subclinical SS. Main sialographic findings was sialectasis of terminal ducts with irregular dilation of main duct. Frequency of RPS was markedly decreased in the patients treated with thymosin. CONCLUSION: The proposal of subclinical SS has theoretical value for understanding the entity and reclassification of chronic suppurative parotitis, and has guide value for diagnosis and treatment of SS in the early stage. Injection of thymosin is considered an effective therapy to reduce RPS in subclinical SS.

Adolescent↗
PubMed2001

The Advanced Glaucoma Intervention Study (AGIS): 10. Variability among academic glaucoma subspecialists in assessing optic disc notching.

PURPOSE: An analysis of data from the Advanced Glaucoma Intervention Study (AGIS) has found eyes reported to have partial optic disc rim notching (not to the edge) at baseline to have less risk of subsequent visual field loss than eyes with no notching. Because this is counterintuitive and because classification of notching had not been defined in the AGIS protocol, we have assessed AGIS ophthalmologists interobserver and intraobserver agreement on notching. METHODS: Fourteen glaucoma subspecialists classified notching in 26 pairs of stereoscopic disc photographs of eyes with mild to severe glaucomatous optic neuropathy. They classified images as showing either no notching, notching not to the edge, or notching to the edge. Several hours later, 10 of them classified the same images a second time. RESULTS: In an analysis of interobserver agreement, of 26 stereoscopic images, a plurality of ophthalmologists classified notching as absent in 9 (35%), as present but not to the edge in 7 (27%), and as present and not to the edge in 10 (38%). All 14 ophthalmologists (100%) agreed on the classification of 7 (27%) of the images, and 13 of the 14 ophthalmologists (93%) agreed on the classification of 4 additional images (15%). Of these 11 images with at least 93% agreement, notching was reported as absent in 3 (27%) and to the edge in 8 (73%). In the remaining 15 images, there was substantial disagreement about whether notching was present and, if so, whether it was to the edge. In an analysis of intraobserver agreement, none of the 10 ophthalmologists who completed the viewing a second time classified all eyes exactly the same as the first time, though 5 ophthalmologists made 4 or fewer reclassifications. Overall, 80% of the original classifications were reproduced on second reading. Of the initial classifications that were not reproduced, slightly more than half were first classified as having notching not to the edge. CONCLUSION: Without definitions or examples of optic disc rim notching, the glaucoma subspecialists had relatively high intraobserver agreement but were likely to disagree with each other in characterizing the degree of disc rim notching. We recommend development of a standard photographic classification of disc rim notching. The classification should be tested for inter- and intra-observer agreement.

Academic Medical Centers↗
PubMed2002

[Chlamydial diseases of domestic animals--zoonotic potential of the agents and diagnostic issues].

The role of chlamydiae as agents of a number of important animal and human diseases is still the subject of intensive research. Recently, a proposal for taxonomic reclassification of this group of obligate intracellular bacteria was published, which was based on a large amount of new data on genetic relatedness. According to this proposal, the family Chlamydiaceae now comprises two genera (Chlamydia and Chlamydophila) with 9 largely host-related species. The previously accepted classification scheme had distinguished 4 species within the genus Chlamydia. The most important animal chlamydiosis with zoonotic character is psittacosis, a systemic disease in psittacine birds of acute, protracted, chronic or subclinical manifestation. The analogous infection in domestic and wild fowl is known as ornithosis. Avian strains of C. psittaci (new classification: Chlamydophila psittaci) can also infect humans, the symptoms being mainly unspecific and influenza-like, but severe pneumonia, endocarditis and encephalitis are also known. The main group of persons facing an elevated risk of infection includes those having frequent contact with domestic and companion birds at work or in their spare time. In Germany, the annual average of notified cases is approximately 100. Cases of transmission to humans were repeatedly reported in connection with enzootic abortion in sheep (causative agent: C. psittaci or Chlamydophila abortus, respectively). Various chlamydial species occur as pathogens and commensals as well in cattle, pigs, horses, and cats. The assessment of the actual epidemiological importance is, however, often difficult because of their almost ubiquitous spread. Likewise, those strains of C. pneumoniae (new classification: Chlamydophila pneumoniae) found in several animal species can not yet be assessed for pathogenic properties. The possibilities for diagnostic detection of chlamydiae have considerably improved following the introduction of molecular methods, particularly the polymerase chain reaction (PCR), which permits direct identification from clinical specimens and differentiation of species.

Animals↗
PubMed1996

What is a juvenile polyp? An analysis based on 21 patients with solitary and multiple polyps.

BACKGROUND: Juvenile polyps, the most common pediatric gastrointestinal polyp, have been typically characterized as either hamartomatous overgrowths or reactive inflammatory proliferations. Recent observations of excessive colonic and gastric carcinoma and dysplasia in juvenile polyposis have prompted reclassification of this entity as a premalignant condition. The relationship between solitary or multiple juvenile polyps and malignancy is less clear. PATIENTS AND METHODS: To further investigate the frequency and significance of dysplasia in juvenile polyps, we analyzed 28 polyps from 21 patients histologically and immunohistochemically for substances previously associated with neoplastic transformation in the colorectal adenomacarcinoma sequence. RESULTS: Fifteen patients had a solitary polyp, two had 2 to 9 polyps, and four had polyposis with 10 or more polyps. Most polyps exhibited inflammatory or regenerative atypia. Foci of dysplasia were noted in polyps from 11 patients, and immunoreactivity for p53 and human chorionic gonadotropin was present in 12 of the 28 polyps each. These findings were all more frequent in the polyposis specimens than in solitary polyps. CONCLUSIONS: These observations, in combination with reports of an increased risk of carcinoma in juvenile polyposis, suggest that juvenile polyps are lesions with a potential for neoplastic and malignant transformation, although they share features of an inflammatory reactive process. The implications for clinical management of patients and pathologic evaluation of juvenile polyps warrant further investigation.

Child↗
PubMed2002

Histamine receptors: specific ligands, receptor biochemistry, and signal transduction.

During the past few years, there has been a tremendous increase in our understanding of the histamine receptors. Important progress has been made in the development of H1-receptor agonists and the rationalization of H1-receptor-ligand interaction. The recent observation of constitutive H1- and H2-receptor activity has led to a reclassification of H1- and H2-antagonists. For the H3-receptor, a wide variety of selective and potent ligands are currently available and await clinical application. The recent cloning of the H3-receptor gene and the anticipated generation of transgenic mice will facilitate this development. Within the field of signal transduction, a previously unanticipated complexity has been unravelled. With the cloning of the H3-receptor gene, a similar complexity is to be expected.

Animals↗
PubMed1975

Systematic approach to drug information requests.

A five-step systematic technique used for answering drug information requests is described. Step 1 is classification of the request. Step II involves determination of exactly what information is being requested and why, and ensuring that all pertinent background data are obtained. Step III is a systematic search of the literature, beginning with general references and progressing through secondary sources to primary articles. Step IV is formulation of the accumulated data into an appropriate writtern of verbal response. Step V involves reclassification of the request which may be necessary if there is a change in its scope.

Information Services↗
PubMed1989

A study of standards for the differentiation of the urban population in China.

In China, the recent reclassification of the country into urban areas has led to an increase of urban population that is to a large extent purely administrative. To set a standard for differentiating the population into urban and rural, it is necessary to formulate a scientific standard. The author considers the problems and contradictions created by the differentiation of population according to cities and towns which are administratively established. Newly established cities and towns are comparatively large in number and their sizes are much expanded because a certain amount of agricultural population is included in the urban population. A survey of 347 cities revealed that on the average, the agricultural population accounted for 47% of the total. It is important to set the principles for standards of differentiation of the urban population with a view to the origin of the city. All the economic, social, and administrative principles have limitations, and no one set of principles can be used by itself to decide whether or not an area is urban. The standards should be based on actual conditions within China itself.

Asia↗
PubMed2002

Current diagnostic criteria and their impact on outcome and management.

The 1997 American Diabetes Association (ADA) Expert Committee on the Diagnosis and Classification of Diabetes Mellitus and the Provisional Report of the WHO Consultation focus on a fasting plasma glucose (FPG) that is 126 mg/dl or greater and confirmed on a subsequent day as the preferred criterion for the diagnosis of diabetes mellitus. This criterion is supported by studies demonstrating that this threshold accurately differentiates between non-diabetic and diabetic populations and is associated with the development of specific diabetic microvascular complications. It corrects for the inequivalence of the FPG and 2- hour post glucose (2hPG) criteria of the previous National Diabetes Data Group (NDDG) and WHO diagnostic schemes and recognises that oral glucose tolerance tests (OGTTs) rarely are performed in clinical practice. Although the new and the previous criteria produce similar estimates of the prevalence of diabetes, there may be a considerable degree of reclassification. Preliminary studies suggest that the new criteria favour the diagnosis of diabetes in younger and more obese individuals, whereas the older criteria increase the likelihood of diagnosis in older, leaner individuals.

Adolescent↗
PubMed2002

Rural hospital wages and the area wage index.

We examined data on hospital hourly wages and the prospective payment system (PPS) wage index from 1990 to 1997, to determine if incremental changes to the index have improved its precision and equity as a regional cost adjuster. The differential between average rural and urban PPS hourly wages has declined by almost one-fourth over the 8-year study period. Nearly one-half of the decrease is attributable to regulatory and reporting changes in the annual hospital wage survey. Patterns of within-market wage variation across rural-urban continuum codes identify three separate sub-markets within the State-level aggregates defining rural labor markets. Geographic reclassification decisions appear to eliminate one of the three. Remaining systematic within-market rural wage differences work to the reimbursement advantage of hospitals in the smaller and more isolated communities.

Health Care Surveys↗
PubMed2003

[Social inequalities in the city of Rio de Janeiro: a comparison of the 1991 and 1996 censuses].

This article presents a comparative model for the results of the 1996 and 1991 censuses, based on the relations indicated by the results from 1991. The authors conduct a reclassification of the social quality index (SQI) proposed by Najar (1997) for comparison of the two censuses, controlling for the variable "heads of households with 15 or more years of schooling". As is known, the 1996 census was conducted with the purpose of counting the population, and its scope of variables was quite limited. In this sense, the comparison presented here is exploratory and is limited to the variable that registers level of schooling for heads of private, permanent households, seeking to identify some changes. After situating the discussion from the perspective of analytical traditions on which it is based, the authors present and discuss the results, indicating important changes in the way the literature classically interpreted the distribution of social structure in Greater Metropolitan Rio de Janeiro. An increase was observed in years of schooling in the Rio de Janeiro population, especially among female heads of households. From the perspective of methodological tradition, this study is also in keeping with the groundbreaking work of Vetter (1981) and Pin on-Charlot et al. (1986).

Analysis of Variance↗