Biomedical subjects

Scott Robinson

Publications and source records attributed to Scott Robinson.

4 recordsLinked to original sources

PubMed2005

Developing a computer algorithm to identify epilepsy cases in managed care organizations.

The goal of this study was to develop an algorithm for detecting epilepsy cases in managed care organizations (MCOs). A data set of potential epilepsy cases was constructed from an MCO's administrative data system for all health plan members continuously enrolled in the MCO for at least 1 year within the study period of July 1, 1996 through June 30, 1998. Epilepsy status was determined using medical record review for a sample of 617 cases. The best algorithm for detecting epilepsy cases was developed by examining combinations of diagnosis, diagnostic procedures, and medication use. The best algorithm derived in the exploratory phase was then applied to a new set of data from the same MCO covering the period of July 1, 1998 through June 30, 2000. A stratified sample based on ethnicity and age was drawn from the preliminary algorithm-identified epilepsy cases and non-cases. Medical record review was completed for 644 cases to determine the accuracy of the algorithm. Data from both phases were combined to permit refinement of logistic regression models and to provide more stable estimates of the parameters. The best model used diagnoses and antiepileptic drugs as predictors and had a positive predictive value of 84% (sensitivity 82%, specificity 94%). The best model correctly classified 90% of the cases. A stable algorithm that can be used to identify epilepsy patients within MCOs was developed. Implications for use of the algorithm in other health care settings are discussed.

Adult↗

PubMed2005

Estimating prevalence, incidence, and disease-related mortality for patients with epilepsy in managed care organizations.

PURPOSE: The purpose of the present study was to apply computer algorithms to an administrative data set to identify the prevalence of epilepsy, incidence of epilepsy, and epilepsy-related mortality of patients in a managed care organization (MCO). METHODS: The study population consisted of members enrolled in Lovelace Health Plan, a component of Lovelace Health Systems, a statewide MCO headquartered in Albuquerque, New Mexico. Patient records were obtained from July 1996 to June 2001. Four logistic regression models with high sensitivity and specificity were applied to 1-, 3-, and 5-year time frames in which members were continuously enrolled in the MCO. Incidence was defined for patients who did not have an epilepsy-associated code in the 18 months before the first diagnosis entry. Mortality estimates in the population also were assessed by using a matched control group and linkage to a statewide death registry. RESULTS: The data yielded estimated prevalence rates of 7-10 per 1,000, depending on age, sex, ethnicity, and time interval. Annualized incidence was 47 per 100,000 for members continuously enrolled for 3 years and 71 per 100,000 for members continuously enrolled for 5 years. Crude mortality rates were 2-2.5 times higher for epilepsy patients identified with the algorithms than for the matched controls. Conditional logistic regression indicated that the odds of death for epilepsy patients as compared with controls ranged from 1.24 to 2.06. CONCLUSIONS: Accurate estimation of prevalence, incidence, and mortality rates for epilepsy is an essential component of disease management in MCOs. The algorithms in this project can be used to monitor trends in prevalence, incidence, and mortality to inform decisions critical to improving the health care needs and quality of life for patients with epilepsy.

Adult↗

PubMed2004

Mass spectrometric differentiation of alpha- and beta-aspartic acid in a pseudo-tetrapeptide thrombosis inhibitor and its isomer.

The pseudo-tetrapeptide designated here as RGD (N-ethyl-N-[1-oxo-4-(4-piperidinyl) butyl] glycyl-L-alpha- aspartyl-3-cyclohexyl-L-alaninamide) and its isomer with beta-aspartic acid rather than alpha-aspartic acid were examined using electrospray ionization (ESI) and Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS). RGD has potential as a thrombosis inhibitor and the isomer, designated here as isopeptide, is an inactive instability product; hence, means were sought to distinguish the two. Both isomers give a protonated parent on ESI and fragments typical of peptides on sustained off resonance irradiation collision-induced decomposition (SORI-CID). Cleavage at the aspartic acid (b(3)) is the dominant process in both isomers, although a significant b(2) and smaller a(2)" and c(2)" peaks are also observed. More distinctive are peaks observed at b(3)-H(2)O, b(3)-(CO + CO(2)) and, only in the case of the RGD, b(3) - (H(2)O + CO). SORI CID on the b(3) ion indicates that, of these distinctive peaks, only the b(3)-(CO + CO(2)) comes from decomposition of the b(3) ion. On this basis, a mechanism is suggested for b(3) formation, involving proton transfer from a back-bone carbonyl to the aspartic acid side-chain carboxyl group. Such an intramolecular proton transfer involves rings of different sizes for the two isomers, providing a basis for the different SORI energy dependences. A mechanism suggested for the formation of the b(3)-H(2)O fragments also involves proton transfer to the aspartic acid side chain carboxyl group. This leads to concomitant H(2)O loss and amide bond cleavage, giving the b(3)-H(2)O ions with ketene moieties resulting from the water loss. According to the suggested mechanism, the observed loss of CO (verified by SORI-CID on the b(3)- H(2)O ion) from the RGD b(3)-H(2)O peak results in a secondary carbocation stabilized by an adjacent nitrogen. The unobserved loss of CO from the b(3)-H(2)O ion, formed by the suggested mechanism from the isopeptide, would give an unstable primary carbocation lacking a neighboring nitrogen. The mechanism, thus, only rationalizes the observation of a b(3)-(H(2)O + CO) fragment in RGD and not in the isopeptide. The isomers can be distinguished on the basis of this unique peak or on the basis of the different SORI energy dependence of the formation of the b(3) ions.

Aspartic Acid↗

PubMed2003

Determination of Pb complexation in oxic and sulfidic waters using pseudovoltammetry.

Pseudovoltammetry was used to evaluate the actual Pb complexation occurring in natural water samples of varying oxygen and sulfide concentration. In pseudovoltammetry, the potential at which metal-ligand complexes are broken up to form the metal amalgam is used to determine the complexes' thermodynamic stability constants (KTHERM; corrected for metal and ligand side reaction coefficients) via the Nernst expression. This methodology removes the need for any metal additions and for subsequent modeling using fitting criteria, which provide only conditional stability constant data (KCOND). Using known organic ligands, a chelate scale ranging from log KTHERM = 4 to log KTHERM = 20 was developed as a template for comparison with samples collected from two stations of different salinities and at several depths in the Chesapeake Bay. These samples were observed to contain up to five different ligand compounds of unknown structural composition (log KTHERM > 8) with the strongest ligand fraction exceeding log KTHERM > 39 (the maximum observable thermodynamic stability constant due to the reduction of Na+). One possible explanation for the observed complexation is the existence of lead sulfide clusters. This was supported by laboratory experiments using electrochemistry and ICR-FTMS, which confirmed the formation of electrochemically inert multinuclear clusters with high stability constants (e.g., M3S3, log KTHERM = 62.9). However, in all field samples, (sub)nanomolar levels of acid-leachable sulfide were recovered at pH 5.0-6.2, which could be attributed to dissociation of lead sulfide complexes with moderate acidity. Recovery of sulfide increased from < 10% of the total dissolved Pb concentration (Pbdiss) in surface waters to 100% of the Pbdiss in the sulfide-rich bottom waters at the higher salinity location.

Electrochemistry↗