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Biomedical subjects

E O'Neil

Publications and source records attributed to E O'Neil.

18 recordsLinked to original sources
PubMed2005

INFERNO: a system for early outbreak detection and signature forecasting.

OBJECTIVE: Public health surveillance systems that monitor daily disease incidence provide valuable information about threats to public health and enable public health authorities to detect enteric outbreaks rapidly. This report describes the INtegrated Forecasts and EaRly eNteric Outbreak (INFERNO) detection system of algorithms for outbreak detection and forecasting. METHODS: INFERNO incorporates existing knowledge of infectious disease epidemiology into adaptive forecasts and uses the concept of an outbreak signature as a composite of disease epidemic curves. RESULTS: Four main components comprise the system: 1) training, 2) warning and flagging, 3) signature forecasting, and 4) evaluation. The unifying goal of the system is to gain insight into the nature of temporal variations in the incidence of infection. Daily collected records are smoothed initially by using a loess-type smoother. Upon receipt of new data, the smoothing is updated; estimates are made of the first two derivatives of the smoothed curve, which are used for near-term forecasting. Recent data and near-term forecasts are used to compute a five level, color-coded warning index to quantify the level of concern. Warning algorithms are designed to balance false detection of an epidemic (Type I errors) with failure to correctly detect an epidemic (Type II errors). If the warning index signals a sufficiently high probability of an epidemic, the fitting of a gamma-based signature curve to the actual data produces a forecast of the possible size of the outbreak. CONCLUSION: Although the system is under development, its potential has been demonstrated through successful use of emergency department records associated with a substantial waterborne outbreak of cryptosporidiosis that occurred in Milwaukee, Wisconsin, in 1993. Prospects for further development, including adjustment for seasonality and reporting delays, are also outlined.

Algorithms↗
PubMed2005

Evaluation of a hypertension screening programme in Independence, Belize.

This study assesses the effectiveness of a hypertension-screening programme in Independence, Belize. Forty-nine of the 101 patients screened were found to have elevated blood pressure readings and were advised to seek medical care. Four months later, interviews with 35 of the 49 patients from the hypertensive group revealed that 85.7% of the patients had sought medical care. Women, elderly patients and patients with a previous history of hypertension were more likely than men, younger patients and those without a history of hypertension to seek follow-up medical care. The screening programme successfully directed a high proportion of patients with elevated blood pressure to seek appropriate medical care.

Adolescent↗
PubMed1999

Differences in curriculum emphasis in US undergraduate and generalist residency education programmes.

OBJECTIVES: Little attention has been paid to the differential emphasis undergraduate and graduate medical education programmes place on the broad competencies that will be needed for practice in an increasingly managed health care environment. The purpose of this study was to determine differences in emphasis that undergraduate and primary care graduate medical education programmes are currently placing on 33 broad practice competencies, compared with the emphasis they ideally would like to give them, and the barriers they perceive to curriculum change. DESIGN: Subjects were surveyed by mailed questionnaire. A reminder postcard and follow-up mailing were sent to non-respondents. SETTING: US allopathic medical schools. SUBJECTS: Academic deans identified by the Association of American Medical Colleges (AAMC) and generalist (family medicine, internal medicine, paediatrics and obstetrics-gynaecology) residency programme directors identified by the American Council on Graduate Medical Education (ACGME). RESULTS: Findings revealed that residency programmes placed greater emphasis on the study's broad curriculum topics than did undergraduate medical education programmes. Statistically significant differences were found in current emphasis for 12 topics and ideal emphasis for six topics. Both groups identified an already crowded curriculum and inadequate funding as the top two barriers to curriculum change. CONCLUSIONS: The differences in curriculum emphases and perceived barriers to curriculum change most probably reflect the different realities of undergraduate and graduate medical education programmes, i.e. academics vs. a focus on immediate practice realities.

Curriculum↗
PubMed1998

Trends among biomedical investigators at top-tier research institutions: a study of the Pew Scholars.

PURPOSE: To gather information and opinions from promising young scientists at top-tier research institutions to learn how they are being affected by the changing biomedical research environment and to present highlights from some of the major reports in the literature on trends in biomedical education and employment in the United States. METHOD: In 1996, the authors conducted a survey of all individuals who had been chosen as awardees in the Pew Scholars Program in the Biomedical Sciences between 1985 and 1995. This group was chosen because it represents independently-identified highly successful investigators at top-tier biomedical research institutions in the United States. RESULTS: Overall, the members of the study group performed better than did their peers nationwide regarding time to degrees, ages at first position, and first awards of federal funding. Nonetheless, even within this above-average cohort, trends were identified that indicate a general aging of young scientists. Not surprisingly, members of this cohort had greater access to federal funds for training and were more likely to pursue careers in academia than their peers nationwide. Despite the success of this well-positioned cohort of scientists, their views on the job market, the supply of biomedical scientists, and the training of students were surprisingly pessimistic. CONCLUSION: The study findings provide information about early career paths of investigators at top-tier research institutions. In addition, the views of this successful cohort serve to inform the current dialogue and questions that remain about the future health of biomedical research and education in the United States. Educators, prospective and current students, and members of the policy community may find it useful to consider these findings and the questions they raise, some of which the authors present.

Academies and Institutes↗
PubMed1998

The transformation of academic health in the United States.

Like all health care institutions, the nation's academic health centers are facing the need for fundamental change in structure and opportunity. This article examines the trends in five major areas: research, higher education, specialization, finance, and organization. The impact of these trends on the academic health centers is explored.

Academic Medical Centers↗
PubMed1996

Germ-line BRCA1 mutations in Jewish and non-Jewish women with early-onset breast cancer.

BACKGROUND: Mutations in a germ-line allele of the BRCA1 gene contribute to the familial breast cancer syndrome. However, the prevalence of these mutations is unknown in women with breast cancer who do not have the features of this familial syndrome. We sought BRCA1 mutations in women who were given a diagnosis of breast cancer at an early age, because early onset is characteristic of a genetic predisposition to cancer. METHODS: Clinical information and peripheral-blood mononuclear cells were obtained from 418 women from the Boston metropolitan area in whom breast cancer was diagnosed at or before the age of 40. A comprehensive BRCA1 mutational analysis, involving automated nucleotide sequencing and a protein-truncation assay, was undertaken in 30 of these women, who had breast cancer before the age of 30. In addition, the BRCA1 mutation 185delAG, which is prevalent in the Ashkenazi Jewish population, was sought with an allele-specific polymerase-chain-reaction assay in 39 Jewish women among the 418 women who had breast cancer at or before the age of 40. RESULTS: Among 30 women with breast cancer before the age of 30, 4 (13 percent) had definite, chain-terminating mutations and 1 had a missense mutation. Two of the four Jewish women in this cohort had the 185delAG mutation. Among the 39 Jewish women with breast cancer at or before the age of 40, 8 (21 percent) carried the 185delAG mutation (95 percent confidence interval, 9 to 36 percent). CONCLUSIONS: Germ-line BRCA1 mutations can be present in young women with breast cancer who do not belong to families with multiple affected members. The specific BRCA1 mutation known as 185delAG is strongly associated with the onset of breast cancer in Jewish women before the age of 40.

Adult↗
PubMed1992

Health of the public. The academic response. Health of the Public Mission Statement Working Group.

Aging of the population, increasing prevalence of chronic and disabling illnesses with multiple social and behavioral risk factors, concern about quality of care, and escalating costs of medical care require fundamental changes in the way that academic health centers discharge their mission. This article describes a newly developed "Mission Statement" for academic health centers that wish to contribute positively to the health of the populations that they serve. A shift toward addressing the needs of the public may produce increasing institutional strength, long-run stability, and enhanced productivity, as well as higher quality, more cost-effective care for patients. Seventeen centers in the Health of the Public Program are currently conducting activities that implement the described mission elements. The goals and objectives described herein create a foundation for change, with more balanced institutional goals, and could turn an emerging confrontation between academe and its public into an opportunity for both.

Academic Medical Centers↗
PubMed1991

Evolution of renal insufficiency in ischemic nephropathy.

This retrospective review of data collected during a recent 42-month period from 58 consecutive patients with ischemic nephropathy submitted to operative management in the authors' center was undertaken to report the rate of decline in their renal function during the period before intervention and to examine the impact of operation on their outcome. Based on serum creatinine values, immediate preoperative estimated glomerular filtration rates (EGFR) ranged from 0 to 46 mL/minute (mean, 23.85 +/- 9.76 mL/minute). Eight patients were dialysis dependent or anuric at the time of operation. Patients with at least three sequential measurements for calculations of EGFR changes during the 6 months before operation (n = 50) and the first 12 months after operation (n = 32) were used to describe the preoperative rate of decline in EGFR and the impact of operation on this decrease in the operative survivors. In addition comparative analyses of data from patients with unilateral versus bilateral lesions and patients classified as having improvement in EGFR versus no improvement after operation were performed. Comparison of the immediate preoperative EGFR with the immediate postoperative EGFR for the entire group showed significant improvement in response to operation. Likewise the rate of deterioration in EGFR for the total group was improved after operation. A similar improvement in the rate of deterioration in EGFR was seen in the subgroup of patients who received an immediate improvement in EGFR in response to operation. These data argue that ischemic nephropathy is a rapidly progressive form of renal insufficiency. Although individual responses to operation were heterogeneous, renal revascularization may provide both immediate improvement in renal function and an improvement in its rate of deterioration during follow-up in patients with ischemic nephropathy.

Adult↗
PubMed1985

Age-related changes in cardiac muscarinic receptors: decreased ability of the receptor to form a high affinity agonist binding state.

Cardiac ventricular muscarinic cholinergic receptors and agonist binding properties were determined in Fischer 344 rats at 3, 12, and 24 months of age. Muscarinic receptors were determined by specific (-)-[3H]quinuclidinyl benzilate (QNB) binding, and the agonist binding properties were determined by competition assays. There were no differences in the concentration of the receptor or the dissociation constant of [3H]QNB binding among the three age groups. In cardiac membranes from 3- and 12-month-old animals, 5'-guanylyl-imidodiphosphate (Gpp(NH)p) increased by 16- to 18-fold (p less than .01) the concentration of carbachol required to inhibit [3H]QNB binding by 50% (IC50). At 24 months, however, Gpp(NH)p induced only a 2.7-fold shift in the carbachol IC50 value (p less than .01). The reduced shift was due to an increase in the carbachol IC50 value determined in the absence of Gpp(NH)p (p less than .01). There was no significant differences among the 3-, 12-, and 24-month-old animals in the half-maximal concentration of Gpp(NH)p required to produce the carbachol IC50 shift. The data indicated that with age there is a reduced ability of the muscarinic receptor to form a high affinity agonist binding state.

Aging↗