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Biomedical subjects

M MacDowell

Publications and source records attributed to M MacDowell.

7 recordsLinked to original sources
PubMed2001

How are age and payors related to avoidable hospitalization conditions?

OBJECTIVE: (1) Examine variations in AHC indicators across age groups and payor types; (2) evaluate the impact of individual and community characteristics on AHC indicators; and (3) investigate the effect of adjustment for age and other factors on AHC indicators. MCOs can use AHC hospitalization and inpatient days to develop focused strategies in reducing AHC hospitalization. But biased comparisons often occur without adjustment for confounding factors. This study demonstrates that age and age/gender adjustments are needed for privately insured and Medicare patients while additional adjustment for community characteristics is needed for Medicaid and Self-Pay patients.

Adolescent↗
PubMed1966

The renal lesions of electrolyte imbalance. IV. The intranephronic calculosis of experimental magnesium depletion.

A dietary depletion of magnesium in rats leads to the production in the thin limb of Henle's loop of the nephrons of spherical microliths composed of a matrix of PAS-positive substances and calcium phosphate (3). These microliths grow by accretion to form intranephronic calculi. The classical pathological syndrome of clinical nephrolithiasis is thus reproduced within the nephron; to wit, the origin of the calculus at a certain level, local traumatic damage at the site of its origin, passage with the fluid flow down the urinary passages, lodgment of the calculus at some restricting point, obstruction of fluid flow and the usual consequent localized intrarenal "hydronephrotic" alterations of regressive atrophic cellular dysplasias within the nephron. To the classical description of the two forms of urinary lithiases occurring in the bladder and in the renal pelvis must therefore be added a third form, intranephronic calculosis. From the first origin of a microlith to its ultimate form as a calculus its organized structure is characterized by its matrix (PAS-positive materials) in which the periodic precipitation of crystalline mineral (Ca(++), PO(3) (---)) occurs in a pattern simulating Liesegang rings.

Animals↗
PubMedDate not supplied

Understanding birthing mode decision making using artificial neural networks.

BACKGROUND: This study examined obstetricians' decisions to perform or not to perform cesarean sections. The aim was to determine whether an artificial neural network could be constructed to accurately and reliably predict the birthing mode decisions of expert clinicians and to elucidate which factors were most important in deciding the birth mode. METHODS: Mothers with singleton, live births who were privately insured, nonclinic, non-Medicaid patients at a major tertiary care private hospital were included in the study (N = 1508). These mothers were patients of 2 physician groups: a 7-obstetrician multispecialtygroup practice and a physician group of 79 independently practicing obstetricians affiliated with the same hospital. A feedforward, multilayer artificial neural network (ANN) was developed and trained. It was then tested and optimized until the most parsimonious network was identified that retained a similar level of predictive power and classification accuracy. The performance of this network was further optimized using the methods of receiver operating characteristic (ROC) analysis and information theory to find the cutoff that maximized the information gain. The performance of the final ANN at this cutoff was measured using sensitivity, specificity, classification accuracy, area under the ROC curve, and maximum information gain. RESULTS: The final neural network had excellent predictive accuracy for the birthing mode (classification accuracy = 83.5%; area under the ROC curve = 0.924; maximum information = 40.4% of a perfect diagnostic test). CONCLUSION: This study demonstrated that a properly optimized ANN is able to accurately predict the birthing mode decisions of expert clinicians. In addition to previously identified clinical factors (cephalopelvic disproportion, maternal medical condition necessitating a cesarean section, arrest of labor, malpresentation of the baby, fetal distress, andfailed induction), nonclinical factors such as the mothers' views on birthing mode were also found to be important in determining the birthing mode.

Decision Making↗