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PubMed2005

Changes in the utilization of diagnostic codes in neonatology following the introduction of activity-based financing.

Activity-based financing was introduced in public hospitals in Norway in 1997. Following this, hospitals have been financed in part by block grants, in part by grants based on productivity as measured through weighted diagnosis-related groups (DRGs). Insufficient national data were available to allow for proper calculation of DRG weights for neonatology. Thus, data from other countries were used to estimate weights. It seemed of interest to examine whether the use of diagnostic codes in neonatal medicine was changed following the introduction of activity-based financing and DRGs. Data from 1994, 1996, 1998, and 2000 were obtained from the proprietary database of the NICU at Rikshospitalet, University of Oslo, as well as from the hospital Patient Information Management System. Diagnoses were organized into 39 categories, counted for each of the 4 years, and analyzed by non-parametric ANOVA. There were significant changes in the use of diagnostic categories during the 1994-2000 time period. Some diagnoses which previously have been only rarely used, became more frequent. The use of other diagnoses varied in ways that could only be understood in terms of tactical usage. It is concluded that the use of DRGs as a basis for activity-based financing may result in changes in the use of certain diagnostic categories which are not related to biological changes in the patient population. This may complicate epidemiological research. On the other hand, activity-based financing may result in increased attention to the diagnostic process, leading to increased use of secondary diagnoses and thus more complete diagnostic coding.

Diagnosis-Related Groups↗
PubMed1977

Vertical eye movement related unit activity in the rostral mesencephalic reticular formation of the alert monkey.

Eye movement related unit activity was recorded in the rostral mesencephalic reticular formation (MRF) of the alert monkey. Most units (78 out of 117) were activated with a short activity burst starting before the eye movement and were otherwise silent. The activity was the same whether movements occurred spontaneously in the light or dark, or were fast phases of vestibular or optokinetic nystagmus, and could be related to parameters of a vector representing the eye movement such as amplitude, position changes along certain planes or direction of movements. Units coding position changes or direction of movement had their preferred direction always close to the vertical. Other units (18 out of 117) showed some tonic activity, which was also only related to vertical eye position. It is suggested that this region of the rostral MRF acts an an immediate supranuclear structure, mediating eye movements in the vertical plane.

Action Potentials↗
PubMed2001

A multiple-site-specific heteroduplex tracking assay as a tool for the study of viral population dynamics.

Rapidly evolving entities, such as viruses, can undergo complex genetic changes in the face of strong selective pressure. We have developed a modified heteroduplex tracking assay (HTA) capable of detecting the presence of single, specific mutations or sets of linked mutations. The initial application of this approach, termed multiple-site-specific (MSS) HTA, was directed toward the detection of mutations in the HIV-1 pro gene at positions 46, 48, 54, 82, 84, and 90, which are associated with resistance to multiple protease inhibitors. We demonstrate that MSS HTA is sensitive and largely specific to all targeted mutations. The assay allows the accurate and reproducible quantitation of viral subpopulations comprising 3% or more of the total population. Furthermore, we used MSS HTA in longitudinal studies of pro gene evolution in vitro and in vivo. In the examples shown here, populations turned over rapidly and more than one population was present frequently. To demonstrate the versatility of MSS HTA, we also constructed a probe sensitive to changes at positions 181 and 184 of the RT coding domain. Changes at these positions are involved in resistance to nevirapine and 2',3'-dideoxy-3'-thiacytidine (3TC), respectively. This assay easily detected the evolution of resistance to 3TC. MSS HTA provides a rapid and sensitive approach for detecting the presence of and quantifying complex mixtures of distinct genotypes, including genetically linked mutations, and, as one example, represents a useful tool for following the evolution of drug resistance during failure of HIV-1 antiviral therapy.

Antiviral Agents↗
PubMed2003

Validation of data collection for the HEDIS performance measure on chlamydia screening in an MCO.

OBJECTIVE: To determine the validity of calculating the chlamydia Health Plan Employer Data and Information Set (HEDIS) measure using administrative data available in a mixed-model managed care organization (MCO). STUDY DESIGN: Retrospective cohort study. METHODS: A review of International Classification of Diseases, Ninth Revision (ICD-9), Current Procedural Termin-ology (CPT), Healthcare Common Procedure Coding System (HCPCS), and National Drug Code codes and electronic laboratory files in 1998 and a medical chart review to validate sexual activity and chlamydia testing codes specified by the National Committee for Quality Assurance (NCQA) in 1999 for the chlamydia HEDIS 2000 measure. RESULTS: Fewer than 25% of female enrollees with laboratory evidence of a chlamydia test had a CPT code for chlamydia testing as specified by the NCQA. Non-pathogen-specific test codes instead of NCQA-specified codes were used in 1998 to code chlamydia tests. By incorporating electronic laboratory data into the automated claims-generating process, all chlamydia tests performed at staff-model clinics were coded. Use of pharmacy dispensing data to identify contraceptive prescriptions increased the proportion of enrollees classified as sexually active by 4% to 5% vs documentation of sexual activity using ICD-9, CPT, and HCPCS codes only. CONCLUSIONS: The MCO quality assurance specialists examining chlamydia testing rates under HEDIS may want to evaluate chlamydia testing coding practices in their MCOs to determine whether simple changes in coding practices may present a more accurate picture of actual testing practices. The proportion of female enrollees classified as sexually active using different data available in the staff and network models varied only slightly.

Adolescent↗
PubMed1998

Recent changes to the Internal Revenue Code may require tax-exempt hospitals to restructure ownership of certain activities.

This article by attorney mandarino explores the implications of a 1997 change in the Internal Revenue Code affecting tax-exempt hospitals which run or operate for-profit businesses. The piece explores the application of prior law to hospital ownership of for-profit ventures and continues on to review the implications of the 1997 amendment, particularly on existing structures. The article conclude with suggestions to avoid applications of the amended section.

Commerce↗
PubMed1998

Molecular alterations in the TP53 gene of peripheral blood cells of patients with chronic myeloid leukemia.

The TP53 gene has been extensively studied in patients with chronic myeloid leukemia (CML), both in chronic phase and in blast crisis. Mutations in the gene were found in up to 30% of the patients, especially among those in blast crisis. We report the results of an analysis of 29 blood samples from CML patients: 8 samples from chronic phase patients, 8 from patients in the accelerated phase, and 13 from patients in blast crisis. By using genomic DNA, we sequenced PCR products of the coding exons and most introns of the TP53 gene, finding genetic changes in 30% of the blast crisis samples and 12% in chronic phase. All mutations were found in introns and were previously unreported. Immunocytochemical studies revealed accumulation of TP53 in blood cells of samples both from chronic phase and blast crisis patients. Since these samples had no TP53 mutations, we believe that wild type TP53 accumulates in blood cells of CML patients. Our results, therefore, indicate that molecular changes in coding regions of the TP53 gene are rare. The significance of the abundance of intronic changes should be investigated further. Accumulation of wild type TP53 in CML cells may indicate an additional mechanism involving this gene in the pathogenesis of this disease.

Adult↗
PubMed1999

Combinatorial receptor codes for odors.

The discriminatory capacity of the mammalian olfactory system is such that thousands of volatile chemicals are perceived as having distinct odors. Here we used a combination of calcium imaging and single-cell RT-PCR to identify odorant receptors (ORs) for odorants with related structures but varied odors. We found that one OR recognizes multiple odorants and that one odorant is recognized by multiple ORs, but that different odorants are recognized by different combinations of ORs. Thus, the olfactory system uses a combinatorial receptor coding scheme to encode odor identities. Our studies also indicate that slight alterations in an odorant, or a change in its concentration, can change its "code," potentially explaining how such changes can alter perceived odor quality.

Amino Acid Sequence↗
PubMed1996

UAG is a sense codon in several chlorophycean mitochondria.

The mitochondrial genetic code of those land plants and green algae that have been examined does not deviate from the universal one. A red alga, Chondrus crispus, is the sole reported example throughout the algae that uses a deviant (non-universal) mitochondrial genetic code (UGA=Trp). We have analyzed 366-bp DNA sequences of the gene for mitochondrial cytochrome oxidase subunit I (COXI) from ten chlorophyceaen algae, and detected 3-8 in-frame UAG codons in the sequences of five species. Comparisons of these sequences with those of other algae and land plants have shown that most of the UAG sites in Hydrodictyon reticulatum, Pediastrum boryanum and Tetraedron bitridens correspond to alanine, and those of Coelastrum microporum and Scenedesmus quadricauda to leucine. The three species in which UAG probably codes for alanine are characterized by zoospore formation in asexual reproduction and form a clade in the COXI phylogenetic tree. The two species in which UAG codes for leucine are known to form daughter coenobia and pair in the tree. This is the first report on a deviant mitochondrial genetic code in green algae. Mutational change(s) in the release factor corresponding to UAG would be involved in these code changes. No genetic code deviation has been found in five other species examined.

Alanine↗
PubMed2002

Stability of Wertheimer-Leeper wire codes as a measure of exposure to residential magnetic fields over a 9- to 11-year interval.

The Wertheimer-Leeper (W-L) wire code is a construct used as a surrogate indicator of residential exposure to electromagnetic fields. However, little is known about how changes in electrical distribution systems affect wire code assignment. The wire code was determined for 150 homes in the Seattle, WA, area twice, 9-11 years apart. For each home, the authors evaluated whether the electrical configuration around the home and the wire code changed between the two time points. The effect of wire code misclassification on observable odds ratios was evaluated, given hypothetical true control distributions and two different dose-response curves. There was an electrical configuration change for 77 (51.3%) homes, which resulted in a wire code change for 29 (19.3%) homes. Eight (5.3%) other homes had a wire code change due to mapping errors or methodological inconsistencies. Misclassification masked the shape of a threshold (nonlinear) dose-response curve and changed the slope of a linear dose-response curve. Although the wire code detected less than half of electrical configuration changes, misclassification of exposure over time may change odds ratios and mask possible dose-response relationships.

Electricity↗
PubMed2005

Safe pedestrian crossings for children and elderly.

In May 2000, the Swedish code governing the conduct of drivers at marked crosswalks became stricter with the intent to improve safety and mobility for pedestrians. A crash analysis based on a macro study of all of Sweden suggests that the injury risk in marked, not reconstructed, crosswalks increased by 27% for pedestrians and 19% for bicyclists. The reason for this may be that pedestrians get a false sense of safety with the new code. Reconstructions aiming at lowering speeds are indeed needed for the change of code to be positive. The 90-percentile speed should not exceed 30 km/h or safety will deteriorate. However, low speed by itself may not guarantee optimal safety. Safety can be further improved at sites, which already have been reconstructed to ensure low speeds. Results based on field data collected at sites close to schools in Malmö, Trollhättan and Borås in Sweden, and in-depth studies and other analyses of Finnish and Swedish police-reported crashes, suggest that safety of children and elderly is further improved at sites where visibility, orientation and clarity are sufficient. Also, marking crosswalks may increase yield rates (expected improvement 6%) towards pedestrians; and speed cushions situated at a longer distance from the marked crosswalk increase yield rates towards pedestrians and cyclists compared to speed cushions closer by.

Accidents, Traffic↗
PubMed1985

The use of comparability ratios to adjust hospital trend data.

Hospital trend data may be affected by changes in diagnostic coding schemes. We studied the change from ICDA-8 (I-8) to ICD-9-CM (I-9) in a sample of roughly 13,600 double-coded Veterans Administration hospital diagnoses. Comparability ratios were computed and used to adjust trend data which overlap the time period when the shift from I-8 to I-9 occurred. With this adjustment for change in diagnostic coding scheme, apparent diagnostic trends are substantially altered.

Diagnosis↗
PubMed1993

Cell-specific translational regulation of S-adenosylmethionine decarboxylase mRNA. Dependence on translation and coding capacity of the cis-acting upstream open reading frame.

The mRNA encoding S-adenosylmethionine decarboxylase (AdoMetDC) has a 330-nucleotide 5'-transcript leader containing an open reading frame (uORF) that codes for the hexapeptide MAGDIS. The uORF restricts the intracellular distribution of AdoMetDC mRNA primarily to monosomes in normal T-lymphocytes and in T-cell lines. In contrast, non-lymphoid cells normally carry an average of seven to nine ribosomes per AdoMetDC mRNA molecule (Hill, J.R., and Morris, D. R. (1992) J. Biol. Chem. 267, 21886-21893). Several alterations abolish the negative regulatory effect of the uORF in T-cells. These include removing the site of translational initiation; weakening the context of the translational initiation site; changing the coding capacity of the fourth, fifth, and sixth codons; increasing the length of the uORF at either the 5' or 3' end; or changing the primary order of the codons. In contrast, altering the nucleic acid sequence of the uORF at degenerative positions without changing the amino acid coding capacity did not cause deregulation. The uORF does not regulate translation in the trans-configuration. Our results support a model in which translation of the uORF generates a nascent hexapeptide that interacts with its translating ribosome to suppress translation of AdoMetDC mRNA in a cell-specific manner. Structural features of the carboxyl-terminal 3 amino acids of the putative hexapeptide govern the interaction of the peptide with a component of the translation machinery.

Adenosylmethionine Decarboxylase↗
PubMed1998

Herbicide resistance caused by spontaneous mutation of the cytoskeletal protein tubulin.

The dinitroaniline herbicides (such as trifluralin and oryzalin) have been developed for the selective control of weeds in arable crops. However, prolonged use of these chemicals has resulted in the selection of resistant biotypes of goosegrass, a major weed. These herbicides bind to the plant tubulin protein but not to mammalian tubulin. Here we show that the major alpha-tubulin gene of the resistant biotype has three base changes within the coding sequence. These base changes swap cytosine and thymine, most likely as the result of the spontaneous deamination of methylated cytosine. One of these base changes causes an amino-acid change in the protein: normal threonine at position 239 is changed to isoleucine. This position is close to the site of interaction between tubulin dimers in the microtubule protofilament. We show that the mutated gene is the cause of the herbicide resistance by using it to transform maize and confer resistance to dinitroaniline herbicides. Our results provide a molecular explanation for the resistance of goosegrass to dinitroanaline herbicides, a phenomenon that has arisen, and been selected for, as a result of repeated exposure to this class of herbicide.

Cells, Cultured↗
PubMed2006

Trends in maternal request cesarean delivery from 1991 to 2004.

OBJECTIVE: To review definitions and terminology for and to estimate percentages of maternal request cesarean deliveries in the United States between 1991 and 2004. METHODS: National Hospital Discharge Survey data 1991-2004 (N=458,767) were used to identify maternal request cesarean deliveries. After excluding women with a history of cesarean delivery, women who labored, and women with indicated risks against labor, 2,394 potential maternal request cesarean deliveries remained. Indicated risks were identified with a recognized protocol. RESULTS: Maternal request cesarean deliveries have two properties: 1) cesarean delivery before labor and 2) cesarean delivery in the absence of medical conditions presenting a risk for labor. Risk is either absolutely absent or it is relatively absent. In 1991-2004, 0.20% of women who delivered live infants and 1.34% of women who delivered by primary cesarean delivery did so without any medical conditions listed on their hospital discharge record. Estimates for maternal request cesarean deliveries without certain indicated risks were 0.75% for women who delivered live infants and 5.03% for women who delivered by primary cesarean delivery. Maternal request cesarean deliveries without any indicated risk peaked in 1999 for women who delivered live infants. Maternal request cesarean deliveries without certain indicated risks crested in 2004. CONCLUSION: Our estimates were affected by three factors: 1) lack of agreement on a definition of maternal request cesarean deliveries, 2) changes in medical coding practices, and 3) changes in physician response to medical conditions. To validly and reliably estimate maternal request cesarean deliveries requires an empirically tractable, standard definition. LEVEL OF EVIDENCE: III.

Adolescent↗
PubMed2004

[Mutations of human papillomavirus (HPV) 16 type L1 genes from cervical carcinoma biopsies in southern Xinjiang Uygur women].

OBJECTIVE: To study the mutations of Human Papillomavirus (HPV) 16 type L1 genes of cervical carcinoma biopsies from Uygur women in Southern Xinjiang, and analyze changes of L1 protein function. METHODS: The tissue DNA was extracted from cervical carcinoma biopsies. HPV16 L1 genes were amplified by PCR from the DNA HPV16 type L1 genes were sequenced and analyzed. RESULTS: The result of PCR showed that the positive rate of HPV16 L1 was 84.21% (16/19). These DNA were sequenced, and we found some mutations in comparison with the previously published sequence of prototype HPV16 L1. Some of the mutations changed the triplet codes, subsequently led to changes of amino acids. The mutations of all thirteen HPV16 L1 fragments formed six patterns (XJL1-1 approximately XJL1-6) at nucleic acid level. Compare to HPV16 prototype, their homology were 99.69% to 99.87%. There were four mutations in nucleic acid sequences of XJL1-1, which occurred also in XJL1-2 approximately XJL1-6. Moreover, there are other mutations in XJL1-2 approximately XJL1-6 besides the four mutations in XJ L1-1. The mutations of all thirteen HPV16 L1 fragments formed four patterns at amino acid level, among the mutations XJL1-1/2/3 was by 76.92% (8/13). CONCLUSION: HPV16 type L1 genes from cervical carcinoma biopsies occurred some mutations in Uygur women from southern Xinjiang, and formed several patterns as well as mainstream pattern. The mutations of L1 proteins changed its hydrophobicity and antigenicity. The research suggested that the mutations of HPV16 type L1 genes associated with HPV16 phylogenesis and escape from immune recognition.

Adult↗
PubMed1998

Drowning surveillance: how well do E codes identify submersion fatalities.

OBJECTIVES: The aim was to determine in New Zealand: (1) to what degree the International Classification of Diseases Supplementary Classification (ICD) external cause (E) codes for drowning identify all deaths involving drowning; (2) how the other drowning deaths are distributed across E codes; and (3) whether the proportion of drownings not identified by traditional ICD E codes has changed over time. METHODS: Mortality files for the period 1977-92, which were coded in the range E800-E999 (external causes of injury and poisoning), were searched electronically using the keyword "drown". RESULTS: 2718 cases that involved drowning were identified. This represents a 17.7% increase in the number of cases one would identify using ICD drowning E codes alone. The majority (65%) of the 408 drownings not coded as such were coded as motor vehicle traffic crashes. The number of drownings that were not identified by ICD E codes remained relatively constant over time, although the number of deaths E coded as drowning declined significantly in recent years. CONCLUSION: Standard ICD E codes for drowning do not identify all drowning related deaths, which may make comparisons of injury rates between countries difficult, especially for injuries such as drownings and burns that can be both nature of injury and external cause codes. Multiple cause coding and the inclusion of free text narratives are an important tool to improve the value of a country's vital statistics for injury prevention, and facilitate comparisons with other countries.

Cause of Death↗
PubMedDate not supplied

[Cochlear implants in post-lingual persons: results during the first five years of the clinical course].

Abundant literature is available on the results of cochlear implants in postlingual persons. Nevertheless, there are few long-term studies with a follow-up of more than 1 year. We present the outcomes of 37 postlingual patients with a 5-year follow-up period. We examined the modifications that occurred with changes in coding strategy (MPEAK-SPEAK). After activation, the coding strategy was SPEAK in 10 patients. MPEAK in 20: 7 other SPEAK had changed from MPEAK. Significant improvement (p < 0.01) was observed in all the tests in the first 6 months. Subsequent assessments revealed a constant improvement in all tests. The results were statistically significant (p < 0.05) for vowels, consonants and bisyllables. Performance with the SPEAK strategy was better than with MPEAK. These results were statistically significant for consonants (p < 0.05), monosyllables (p < 0.05) and bisyllables (p < 0.01). We concluded that the results of postlingual patients after cochlear implantation showed clear benefits of these devices in profound bilateral deafness, better results with the SPEAK coding strategy than with MPEAK and constant improvement in results, even after the first year of surgery.

Adolescent↗