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PubMed1999

Invasive vs conservative management of non-Q-wave myocardial infarction.

In the Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) trial, most patients with non-Q-wave myocardial infarction (MI) fared no better with early invasive management (i.e., diagnostic angiography within 2 to 3 days, followed by revascularization if indicated) than with a more conservative approach (i.e., radionuclide ventriculography and thallium stress testing as initial diagnostic tests). These results should not be construed to diminish the value of early diagnostic angiography, which in patients with non-Q-wave MI provides essential information for determining the need, timing, and method of revascularization. Until more information is available that incorporates contemporary practices and outcomes in patients with non-Q-wave MI, early coronary angiography should remain an acceptable method of risk stratification and should be followed by appropriate medical therapy or revascularization.

Aged↗

PubMed1999

Estimating temporal independence of radio-telemetry data on animal activity

Radio-telemetry is an excellent tool for gathering data on the biology of animals and their interactions with the environment they inhabit. Many methods have been developed for analyses of spatial information, on home range size and utilization density. Activity patterns are often described using radio-tracking data, but no generally accepted method is currently available specifically for determining the temporal independence of this type of data for statistical inference. Activity rhythms have generally been analysed by ecologists with the assumption that data are temporally independent, or by subjectively fixing an independence interval, based on attributes of their ranging behaviour. Although some good approximations of activity patterns can be obtained in these ways, we underline the need for a functionally correct method of estimating independence interval. Here we use semi-variograms to estimate the minimum interval required for the readings to be sequentially independent. This geostatistical tool is applied to the analysis of data on activity of Chilean foxes (Pseudalopex culpaeus) and Chacoan peccaries (Catagonus wagneri). Data were collected in the field by radio-tracking over 24-hr periods, with readings on activity state taken every 15 min. The spatial dimension in which the theory of geostatistics lies has been transferred into the time dimension, so that the correlation interval is expressed in time units (min). Time of independence as estimated by the variogram was 110 min for foxes, while data on peccaries indicated that they have long periods of activity, more suitable for time-series analysis. Copyright 1999 Academic Press.

Journal Article↗

PubMedDate not supplied

Detection of cytomegalovirus antibody in stored blood products using latex agglutination.

The detection of antibody to cytomegalovirus (CMV) in donor sera is one effective method for the prevention of posttransfusion CMV infection in seronegative recipients. A passive latex agglutination test (CMV Scan, Hynson, Wescott & Dunning, Baltimore, MD) has been shown to be an acceptable method of screening sera from the blood donor population. The procedure for this test, however, does not permit the testing of stored donor blood products. To evaluate the feasibility of testing blood components at various times during storage, the authors examined 25 CMV-positive and 25-CMV negative samples of CPDA-1 plasma from 50 units each of platelets and red cells. Plasma samples from platelets stored at 22 degrees C were tested on each of the 5 days of storage. Samples from red cell units stored at 2 to 6 degrees C were tested on storage Days 1, 2, 4, 6, 8, 10, 12, and 14. Of 250 tests done on plasma from platelet units, there were 123 true-positive and 123 true-negative results (sensitivity and specificity, 98.4%). Of 400 tests on plasma from red cell units, there were 200 true-positive and 198 true-negative results (sensitivity, 100%; specificity, 99.5%). These data show that the CMV Scan test can be used reliably to test segments of CPDA-1 plasma from platelets stored for up to 5 days and from red cells stored for up to 14 days.

Antibodies, Viral↗

PubMed1997

College students' knowledge and attitudes about cesarean birth.

BACKGROUND: Numerous clinicians and researchers have expressed concern about the necessity and potential adverse consequences of many cesarean births in the United States. The purpose of this study was to explore college students' attitudes and beliefs about cesarean section. METHODS: One hundred two college students (66% women) completed a 20-item questionnaire that asked if they viewed cesarean delivery as a potentially negative experience, as a normal or acceptable method of childbirth, and as medically necessary, and asked about their beliefs concerning risk and prevention of cesarean birth. RESULTS: The number of "undecided" responses in the study was striking (7.8% to 69.6% across the 20 items). In general, women and men responded similarly, although women were significantly more likely than men to say they would be profoundly disappointed if their babies had to be delivered by cesarean section. Despite expressing cynicism about the cesarean birth rate (40% agreed that many unnecessary cesarean births occurred) and not viewing the procedure as a normal way of giving birth (47%), most respondents (over 70%) disagreed that giving birth by cesarean would be a negative experience or would make a woman feel like a failure. CONCLUSION: A high level of uncertainty exists about certain aspects of cesarean birth among young women and men, highlighting the need for information for prospective parents. Most college students did not view the cesarean birth experience as either potentially negative or normal. Future research should explore coverage of cesarean birth in childbirth education classes and the roles physicians, nurses, and midwives play in preparing expectant parents for the possibility of cesarean delivery.

Adult↗

PubMedDate not supplied

Michigan's fisheater cohorts: a prospective history of exposure.

Interest in environmental contaminants and their effect on human health emerged as a primary focus in the 1970s following the discovery of significant levels of mercury, dichloro diphenyl trichloroethane (DDT), and polychlorinated bihpenyls (PCBs) in recreationally caught Great Lakes fish. In response to these findings, the Michigan Department of Public Health, in 1971, initiated a series of "fisheater" cohort studies. These studies continue to be conducted today. The evolution of human exposure assessment by serum PCB determination parallels the evolution of more precise and sensitive analytical laboratory procedures over the past 25 years. Early work quantitated PCB with Aroclor 1254 standards. By 1980, the Webb and McCall packed-column method (Webb and McCall, 1972, 1973), which quantitates total PCB with Aroclor 1016 and 1260 standards, had gained the Association of Official Analytical Chemists (AOAC) approval and became the accepted method. This method was used in the 1978-1980 Michigan Great Lakes Fisheater Study, the first sizable study of this kind in the nation. The study confirmed that fisheaters had significantly more exposure (median 21.4 ppb vs 6.6 ppb) than controls. Toxicology studies have indicated the need to quantitate individual PCB congeners, in order to correlate exposure with possible toxicological and health outcomes. Today, capillary column gas chromatography and gas chromatography/mass spectrometry are used to search for trace components of the total PCB dose (Mullen et al., 1984). Because of the legacy of the earlier analytical data, Michigan also continues to conduct packed-column analysis for longitudinal comparisons. The Michigan fisheater study database and registry provide a significantly exposed and historic foundation for research testing health outcome hypotheses.

Cohort Studies↗

PubMedDate not supplied

[Macroprolactin in subjects with hyperprolactinaemia: clinical observations and relations between free PRL and PRL complexed with IgG].

UNLABELLED: In some patients with hyperprolactinaemia a large portion of circulating prolactin is bound to authologous gammaglobulin and therefore it is called macroprolactin or Big-Big-Prolactin (BB-PRL). THE AIM: of the study was to select patients with predominance of macroprolactin and to learn more about the natural course of this disorder, in particular about the possible dependence of the presence of clinical features from the amount of circulating "free" PRL level, and also to search whether the quantitative proportions of both forms of PRL are stable or they change parallel to changes of the total serum PRL level. MATERIAL AND METHODS: We identified 58 patients with hyperprolactinaemia, in whom BB-PRL consisted>or=60% of the total PRL concentration. The predominance of macroprolactin was settled using the well accepted method of polyethylene glycol (PEG) precipitation of large m.w. serum proteins, followed by contemporary immunoradiometric measurement of the total and free PRL levels, and calculation of BB-PRL. Repeating such measurements during the long term observation lasting 6-66 months (mean 33 months), which was possible in 18 our patients (13--with idiopathic hyperprolactinaemia and 5--with pituitary adenoma), we could analyze the relations between both forms of PRL during the specific treatment, after it's cessation and, in few cases--during pregnancy. Apart of that, in 18 patients selected from 53 with idiopathic hyperprolactinaemia, we analyzed the shortterm alterations in the ratio between free and complexed PRL during the metoclopramide PRL stimulation test. RESULTS AND CONCLUSIONS: 1. In hyperprolactinaemic patients with predominance of BB-PRL, there was no direct correlation between the presence of clinical features and the concentration of residual "free" PRL. 2. During the long-term observation, in spite of moderate changes in the total PRL concentration induced by the treatment or it's cessation (excluding pregnancy), the ratio of "free" PRL and BB-PRL remained stable. 3. During the short time of metoclopramide stimulation test, there was a marked rise mainly of the total and "free" PRL concentrations, and, in some tested subjects, the predominance of BB-PRL was lost temporally for 1 to 2 hours.

Adult↗

PubMed1997

Predicting survival in heart failure case and control subjects by use of fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics.

BACKGROUND: Despite much recent interest in quantification of heart rate variability (HRV), the prognostic value of conventional measures of HRV and of newer indices based on nonlinear dynamics is not universally accepted. METHODS AND RESULTS: We have designed algorithms for analyzing ambulatory ECG recordings and measuring HRV without human intervention, using robust methods for obtaining time-domain measures (mean and SD of heart rate), frequency-domain measures (power in the bands of 0.001 to 0.01 Hz [VLF], 0.01 to 0.15 Hz [LF], and 0.15 to 0.5 Hz [HF] and total spectral power [TP] over all three of these bands), and measures based on nonlinear dynamics (approximate entropy [ApEn], a measure of complexity, and detrended fluctuation analysis [DFA], a measure of long-term correlations). The study population consisted of chronic congestive heart failure (CHF) case patients and sex- and age-matched control subjects in the Framingham Heart Study. After exclusion of technically inadequate studies and those with atrial fibrillation, we used these algorithms to study HRV in 2-hour ambulatory ECG recordings of 69 participants (mean age, 71.7+/-8.1 years). By use of separate Cox proportional-hazards models, the conventional measures SD (P<.01), LF (P<.01), VLF (P<.05), and TP (P<.01) and the nonlinear measure DFA (P<.05) were predictors of survival over a mean follow-up period of 1.9 years; other measures, including ApEn (P>.3), were not. In multivariable models, DFA was of borderline predictive significance (P=.06) after adjustment for the diagnosis of CHF and SD. CONCLUSIONS: These results demonstrate that HRV analysis of ambulatory ECG recordings based on fully automated methods can have prognostic value in a population-based study and that nonlinear HRV indices may contribute prognostic value to complement traditional HRV measures.

Aged↗

PubMed2001

Comparison of endotoxin exposure assessment by bioaerosol impinger and filter-sampling methods.

Environmental assessment data collected in two prior occupational hygiene studies of swine barns and sawmills allowed the comparison of concurrent, triplicate, side-by-side endotoxin measurements using air sampling filters and bioaerosol impingers. Endotoxin concentrations in impinger solutions and filter eluates were assayed using the Limulus amebocyte lysate assay. In sawmills, impinger sampling yielded significantly higher endotoxin concentration measurements and lower variances than filter sampling with IOM inhalable dust samplers. Analysis of variance for repeated measures showed that this association remained after controlling for other factors such as replicate, sawmill, sawmill operation, wood type, and interaction terms. Endotoxin concentrations in the swine barns were 10-fold higher on average than in sawmills. These samples demonstrated comparable endotoxin concentration estimates for impinger and filter methods although the variability was lower using the impinger method. In both occupational settings, side-by-side replicates were more uniform for the impinger samples than for the filter samples. This study demonstrates that impinger sampling is an acceptable method for quantitation of area endotoxin concentrations. Further, when sampling is performed with impingers for airborne microorganism quantitation, these same impinger solutions can yield valid endotoxin exposure estimates, negating the need for additional filter sampling.

Air Pollutants, Occupational↗

PubMedDate not supplied

Bioelectrical impedance analysis in dialysis patients.

Identification of malnutrition is imperative in chronic dialysis patients. Bioelectrical impedance (BIA) is a noninvasive method to measure body composition and estimate total body water (TBW), lean body mass (LBM) and body cell mass (BCM). Studies suggest BIA has good reliability as compared to other accepted methods of body composition analysis. Preliminary data also suggest that BIA-derived parameters (reactance and phase angle) predict clinical outcome in chronic hemodialysis patients. Overall, BIA is a promising nutritional assessment tool to monitor health status, long-term follow-up, tailor nutrition support, and detect early subtle losses of LBM in chronic dialysis patients.

Body Composition↗

PubMedDate not supplied

Comparison of Chemstrip uG, Clinitest, and Diastix urine test methods in diabetic children.

The new urine test, Chemstrip uG, was compared with Clinitest and Diastix methods by pediatric diabetic patients and by health care professionals. With the children testing all urine samples (N = 108), accuracy for Chemstrip uG and Clinitest was similar and superior to that of Diastix. When the children tested specimens containing up to only 2.2% glucose (N = 75), all test methods were shown to have generally similar accuracies. The diabetic children, however, preferred Chemstrip uG (P less than 0.02). It is concluded that Chemstrip uG is a clinically useful and acceptable method for self-monitoring of urine glucose in diabetic children.

Adolescent↗

PubMed1981

Assay of delta-aminolaevulinate dehydratase in 10 microL of blood.

A method is presented for the assay of delta-aminolaevulinate dehydratase (EC 4.2.1.24) to be performed on 10 microL of whole blood. Results compare favorably with those obtained with an accepted method (J. Clin. Chem. Clin. Bio-chem. 12: 389-390, 1974) that involves use of 200 microL of blood.

Blood Chemical Analysis↗

PubMed1996

Method for determination of free intracellular and extracellular methylglyoxal in animal cells grown in culture.

Methylglyoxal is present at low levels in most cells as a by-product of glycolysis and a product of lipid and amino acid catabolism. The most widely accepted method for measurement of methylglyoxal involves the derivatization of methylglyoxal with 1,2-diaminobenzene derivatives, such as o-phenylenediamine, followed by quantification of the resulting quinoxaline with high-performance liquid chromatography (HPLC). Here we describe the modification of this procedure for the measurement of free intra- and extracellular methylglyoxal in animal cells grown in culture. Cell harvest and sample volume measurement techniques were developed. Solid-phase extraction prior to methylglyoxal derivatization reduced interferences unique to cell culture, such as the phenol red indicator dye used in most cell culture media, and extended the useful life of the HPLC column. In addition, this extraction step significantly lessened the interference represented by oxidative degradation of nucleic acids to methylglyoxal by perchloric acid under assay conditions. The concentration of free intracellular methylglyoxal in Chinese hamster ovary (CHO) cells grown in culture ranged from 0.7 +/- 0.3 microM (mean +/- 2 standard deviations; n = 4) to 1.2 +/- 0.3 microM (mean +/- 2 standard deviations; n = 7). The concentration of free extracellular methylglyoxal in the growth medium was 0.07 +/- 0.02 microM (mean +/- 2 standard deviations; n = 4), severalfold less than that found inside the cell. A possible explanation for the difference between measured free intracellular and extracellular methylglyoxal levels is that the assay for free intracellular methylglyoxal also measures some reversibly bound methylglyoxal.

Animals↗

PubMed1997

Teenagers' use of emergency contraception in a general practice.

British teenagers who become pregnant commonly express ignorance about emergency contraception. A case-note survey was conducted in a general practice serving about 14,200 people in a Devon market town. Of the 373 registered girls aged 15-19 years, 59 (16%) had consulted for emergency contraception, 19 of them more than once. The oral method (Yuzpe regimen) was prescribed eighty times and 2 girls became pregnant. 4 of the 59 girls who used emergency contraception had subsequent unwanted pregnancies. A consultation for emergency contraception presents an opportunity to discuss more reliable and acceptable methods of contraception.

Adolescent↗

PubMed1981

Size and number of adipocytes and measures of body fat in boys and girls 10 to 18 years of age.

In 111 boys and girls, 10 to 18 yr of age, body density was measured by underwater weighing, and the size of adipocytes in adipose tissue from the buttocks was measured by the osmium tetroxide method. From these two measures, estimates of percentage body fat, total body fat, and adipocyte number were computed for most of the children. Their skeletal age was also calculated by an acceptable method. Across chronological age, the girls have significantly larger mean values of total and percentage body fat and larger and more numerous adipocytes than the boys. The mean number of adipocytes in each sex is within adult levels, as is the mean size of the adipocytes in the girls. The boys' mean adipocyte size is below the adult level. There are negative, significant correlations between percentage body fat and chronological or skeletal age in the boys, and positive significant correlations between total body fat and chronological or skeletal age in the girls. Also, adipocyte size is positively correlated with percentage body fat but only in the boys. With the effects of chronological age removed, percentage body fat was significantly and negatively correlated with skeletal age in boys only. All other correlations among the variables were not statistically significant.

Adipose Tissue↗

PubMed2005

Acceptability of human papillomavirus self testing in female adolescents.

OBJECTIVES: To develop scales assessing acceptability of human papillomavirus (HPV) testing in adolescents, to compare acceptability of self to clinician testing, and to identify adolescent characteristics associated with acceptability. METHODS: Female adolescents 14-21 years of age attending a hospital based teen health centre self collected vaginal samples and a clinician, using a speculum, collected cervicovaginal samples for HPV DNA. Acceptability of and preferences for self and clinician testing were assessed at baseline and 2 week visits. RESULTS: The mean age of the 121 participants was 17.8 years and 82% were black. The acceptability scales demonstrated good internal consistency, reliability, test-retest reliability, and factorial validity. Scores were significantly lower for self testing than clinician testing on the acceptability scale and three subscales measuring trust of the test result, confidence in one's ability to collect a specimen, and perceived effects of testing (p < 0.01). Of those who reported a preference, 73% preferred clinician to self testing. Acceptability scores for both self and clinician testing increased significantly pre-examination to post-examination (p < 0.01). Multivariable analyses demonstrated that race was independently associated with pre-examination and post-examination acceptability of self testing, and that sexual behaviours and gynaecological experiences were associated with specific acceptability subscales. CONCLUSIONS: This sample of adolescents found clinician testing for HPV to be more acceptable than self testing and preferred clinician to self testing. If self testing for HPV is offered in the future, clinicians should not assume that adolescent patients will prefer self testing. Instead, they should educate adolescents about available testing options and discuss any concerns regarding self collection technique or accuracy of test results.

Adolescent↗

PubMed2006

Assessment of CAOS as a training model in spinal surgery: a randomised study.

The objectives of this study were (1) to quantify the benefit of computer assisted orthopaedic surgery (CAOS) pedicle screw insertion in a porcine cadaver model evaluated by dissection and computed tomography (CT); (2) to compare the effect on performance of four surgeons with no experience of CAOS, and varying experience of pedicle screw insertion; (3) to see if CT with extended windows was an acceptable method to evaluate the position of the pedicle screws in the porcine cadaver model, compared to dissection. This was a prospective, randomised, controlled and blinded porcine cadaver study. Twelve 6-month-old porcine (white skinned Landrace) lumbar spines were scanned pre-operatively by spiral CT, as required for the CAOS computer data set. Computer randomisation allocated the specimens to one of four surgeons, all new to CAOS but with different levels of experience in spinal surgery. The usual anatomical landmarks for the freehand technique were known to all four surgeons. Two pedicles at each vertebral level were randomly allocated between conventional free hand insertion and an electromagnetic image guided surgery (NAVITRAK) and 6.5 mm cancellous AO screws inserted. Post-operatively, spiral CT was blindly evaluated by an independent radiologist and the spine fellow to assess the accuracy of pedicle screw placement, by each method. The inter- and intra-observer reliability of CT was evaluated compared to dissection. The pedicle screw placement was assessed as perfect if within the pedicle along its central axis, or acceptable (within < 2 mm from perfect), and measured in millimetres from perfect thereafter. One hundred and sixty-six of 168 pedicles in 12 porcine spines were operated on. Complete data were present for 163 pedicles (81 CAOS, 82 freehand). In the CAOS group 84% of screws were deemed acceptable or perfect, compared to 75.6% with the freehand technique. Screw misplacement was significantly reduced using CAOS (P = 0.049). Seventy-nine percent of CAOS screws were ideally placed compared with 64% with a conventional freehand technique (P = 0.05). A logistic linear regression model showed that the miss placed pedicle screw rate was significantly reduced using CAOS (P = 0.047). CAOS benefited the least experienced surgeons most (the research registrars acceptable rate increased from 70 to 90% and the spine fellow from 76 to 86%). CAOS did not have a statistically significant effect on the experienced consultant spine surgeon increasing from 70 to 79% (P = 0.39). The experienced general orthopaedic surgeon did not benefit from CAOS (P = 0.5). CT compared to dissection showed an intra-observer reliability of 99.4% and inter-observer reliability of 92.6%. The conclusions of this study were as follows: (1) an increased number of pedicle screws were ideally placed using the CAOS electromagnetic guidance system compared to the conventional freehand technique; (2) junior surgeons benefited most from CAOS; (3) we believe CAOS (Navitrak) with porcine lumbar spines evaluated by post operative CT, represents a useful model for training junior surgeons in pedicle screw placement; (4) experienced spine surgeons, who have never used CAOS, may find CAOS less helpful than previously reported.

Animals↗

PubMed2005

Biogeological Raman spectroscopic studies of Antarctic lacustrine sediments.

Analysis of lacustrine sediments is an accepted method for deciphering the palaeoenvironment of a lake's catchment area, as each strata of the sediment gives information about the rock type it was eroded from and also the state of the lake, i.e. oxic or anoxic. Antarctica has long been accepted as a putative analogue for Mars, so the analysis of Antarctic material may give results that can be compared to sediments on Mars. Raman spectroscopy has been selected as the method of analysis as it does not destroy the sample, can be used in situ and requires very little sample preparation. It is a suitable method for analysing both inorganic and organic matter and a miniature spectrometer is currently being developed for use in the field. The results from the spectrometers can serve as a guide for analysing sediments on Mars. It has been shown that Raman spectroscopy can detect and differentiate between oxic and anoxic sediments. Both 1064 and 785 nm wavelengths are suitable for laser excitation of organic and inorganic matter.

Antarctic Regions↗

PubMed2006

A method to standardize gait and balance variables for gait velocity.

Many gait and balance variables depend on gait velocity, which seriously hinders the interpretation of gait and balance data derived from walks at different velocities. However, as far as we know there is no widely accepted method to correct for effects of gait velocity on other gait and balance measures. We developed a simple statistical method to obtain gait and balance variables for each participant that are independent of gait velocity. The first step of our standardization method was the transformation of the gait and balance data to obtain a normal distribution and decrease the influence of outliers. Thereafter, we constructed a formula, based on regression analysis that described how these data varied with gait velocity in each participant during walking without an additional task. Last, this formula was used to standardize the gait and balance data for the effect of gait velocity for each individual participant. As example we present the analysis of mediolateral displacements of the trunk in fit elderly people during walking with and without a dual task.

Aged↗