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PubMed2006

Alternative indicators of fecal pollution: relations with pathogens and conventional indicators, current methodologies for direct pathogen monitoring and future application perspectives.

The ecological and survival characteristics of bacterial, viral and parasitic pathogens vary under environmental conditions, indicating that probably no single indicator organism can predict the presence of all enteric pathogens for all types of waters and different host-associated fecal pollution. If there are true correlations between indicator organisms and pathogens, it is necessary to find out to what extent and under which circumstances these organisms can be used as reliable indicators of fecal pollution. Application of conventional and alternative fecal indicators has greatly enhanced our abilities to predict and reduce health risk associated with the use of surface waters. New molecular-based techniques have shown that combined use of conventional and alternative indicators for fecal pollution increases both the detection sensitivity and specificity of fecal pollution and associated pathogens. In this review, we, therefore, summarize the advantages and limitations of conventional and alternative fecal indicators in terms of predicting pathogen presence as well as current and future methodologies for direct pathogen monitoring in environmental waters. This manuscript is mainly focused on the relationships between microbial fecal indicators and the presence of pathogens, which have not previously been summarized yet and could nicely supplement with recent literature reviews on microbial source tracking.

Animals↗
PubMed2003

Indicators of children's development: considerations when constructing a set of national Child Health Indicators for the European Union.

BACKGROUND: In a recent project, commissioned by the European Union, a set of Child Health Indicators were identified and recommended for use in all Member States. In that work, by a group of European experts, children's development was one of the key areas that were reviewed to clarify its role in this set of indicators. This paper deals with neurological (in a broad sense), social and moral aspects of development; other aspects, such as nutrition and physical growth, mental health, quality of life were dealt with in other areas. METHODS: A number of methods are used to monitor children's neurodevelopment, to identify early deviations that could be treated or alleviated. Few tests fulfil basic criteria of screening and quality of evidence. For Child Health Programmes, developmental surveillance is instead recommended. As a proxy to social development, as part of children's process of adaptation into society, education indicators are recommended, such as suggested by OECD and UNICEF. Moral development is discarded as an indicator, because norms and values vary too much between countries. CONCLUSION: For now the Child Health Indicators of Life and Development Project found no ground to recommend any particular method or combination of methods for a general monitoring of children's neurological, intellectual, language and moral development, and for including the results as national indicators of children's health and well-being in EU. For social development, indicators in the educational area seem most promising, as they have been proposed and used by OECD and UNESCO. In an ambitious monitoring programme, these indicators could be included as determinants of children's health and development.

Adaptation, Psychological↗
PubMed1986

A comparison of Doppler ultrasound waveform indices in the umbilical artery--I. Indices derived from the maximum velocity waveform.

Various Doppler waveform indices have been used for assessment of the fetal circulation. Comparisons were made to show what relations exist between the indices, and to identify any differences or difficulties which might arise from using one as opposed to another in clinical practice. Both normal pregnancy and cases of fetal growth failure were studied. Indices were obtained from the maximum velocity envelope of the umbilical artery waveform using a curve fitting technique. The values were very reproducible for all indices. The FHR, which varied over the entire normal range, did not significantly affect the values of any index. The downstream impedance indices calculated included the AB ratio, pulsatility index (PI) and Pourcelot ratio. These all gave very closely correlated results for normals but discrepancies occurred in the at risk group, where values were elevated. This could be attributed to differences in the underlying distributions. The indices suggested for cardiac contractility were not as closely related to each other, and moreover the differences between them showed no clear pattern. None of the indices varied independently of the others. The rising slope, which is by definition related to the PI, was more highly correlated with the downstream indices than the relative flow rate index.

Blood Flow Velocity↗
PubMed1998

Peak negative myocardial velocity gradient in early diastole as a noninvasive indicator of left ventricular diastolic function: comparison with transmitral flow velocity indices.

OBJECTIVES: We sought to assess the clinical significance of peak negative myocardial velocity gradient (MVG) in early diastole as a noninvasive indicator of left ventricular (LV) diastolic function. BACKGROUND: Peak systolic MVG has been shown useful for the quantitative assessment of regional wall motion abnormalities, but limited data exist regarding the diastolic MVG as an indicator of LV diastolic function. METHODS: Peak negative MVG was obtained from M-mode tissue Doppler imaging (TDI) in 43 subjects with or without impairment of systolic and diastolic performance: 12 normal subjects, 12 patients with hypertensive heart disease (HHD) with normal systolic performance and 19 patients with dilated cardiomyopathy (DCM), and was compared with standard Doppler transmitral flow velocity indices. In a subgroup of 30 patients, effects of preload increase on these indices were assessed by performing passive leg lifting. In an additional 11 patients with congestive heart failure at the initial examination, the measurements were repeated after 26+/-16 days of volume-reducing therapy. RESULTS: Peak negative MVG was significantly depressed both in HHD (-3.9+/-1.3/s, p < 0.01 vs. normal=-7.7+/-1.5/s) and DCM (-4.4+/-1.4/s, p < 0.01 vs. normal). In contrast, transmitral flow indices failed to distinguish DCM from normal due to the pseudonormalization. Transmitral flow velocity indices were significantly altered (peak early/late diastolic filling velocity [E/A]=1.1+/-0.5 to 1.5+/-0.7, p < 0.01; E deceleration time=181+/-41 to 153+/-38 ms, p < 0.01), while peak negative MVG remained unchanged (-5.3+/-2.2 to -5.3+/-2.0/s, NS) by leg lifting. Volume-reducing therapy resulted in the apparent worsening of the transmitral flow velocity pattern toward abnormal relaxation, as opposed to peak negative MVG, which improved by the therapy (p < 0.05). CONCLUSIONS: Peak negative MVG derived from TDI may be a noninvasive indicator of LV diastolic function that is less affected by preload alterations than the transmitral flow velocity indices, and thereby could be used for the follow-up of patients with nonischemic LV dysfunction presenting congestive heart failure.

Adult↗
PubMed2004

[Evaluation of indices indicating elderly long-term care need in municipalities].

OBJECTIVE: To establish a way to evaluate preventive care programs using indices that indicate the status of long-term care need for elderly in municipalities. METHOD: Based on the number of people certified as subject to long-term care need and the number of deaths in Taihaku Ward in Sendai City, 3 indices in 14 junior high school districts in the ward were derived; Healthy Life Expectancy for 65 year old men and women (the period in which certification for long-term care need is not made), Hours of Care Need (age-adjusted standard hours for care need) and the Odds Ratio (age-adjusted relative risk) for the elderly aged 65 years or older. Yearly comparisons of the indices were made for 2000 vs 2001, 2001 vs 2002 and 2000 vs 2002. The relationships between the three indices were further analyzed for 2000, 2001 and 2002. Care Compensation by district (age-adjusted care compensation by district was derived for 2001) and its relationships to Healthy Life Expectancy, Hours of Care Need and the Odds Ratio were analyzed by school district for 2001. RESULTS: 1) The Hours of Care Need by district significantly correlated with the Odds Ratios by district for 2000, 2001 and 2002. Both the Hours of Care Need and the Odds Ratio by district also significantly correlated between 2000 and 2001, between 2001 and 2002 and between 2000 and 2002. Healthy Life Expectancy did not show a significant correlation between 2000 and 2001, between 2001 and 2002 and between 2000 and 2002, for men and women. 2) The 2001 Care Compensation by district was obviously proportional to both Hours of Care Need by district and the Odds Ratio by district but did not correlate with Healthy Life Expectancy by district for men and women. 3) Using the co-relationship of the Hours of Care Need between the years, the percentage of applications for certification for care need by people needing care was estimated at 65% for 2000, 87.5% for 2001 and 101% for 2002. This implies that in 2002 almost all the people who needed care applied for the certification. The 2001 Odds Ratio by district was significantly low in district D and significantly high in district H. CONCLUSIONS: Hours of Care Need correlate well with the Odds Ratio and also with Care Compensation which represents long-term care insurance service expenses. The results clearly indicate that the 3 indices represent the status of care need of the elderly in these districts, even with conservative estimates, after 2002. It is suggested that Hours of Care Need and the Odds Ratio are appropriate as indices to evaluate preventive care programs in municipalities.

Aged↗
PubMed2004

Prescribing indicators. Development and validation of guideline-based prescribing indicators as an instrument to measure the variation in the prescribing behaviour of general practitioners.

BACKGROUND: Differences in prescribing behaviour among general practitioners (GPs). AIM: To formulate and validate clinical prescribing indicators based on general practice guidelines. DESIGN: Validatory study. SETTING: Pharmacies and general practices in the Netherlands in 2003. PARTICIPANTS: A total of 379 pharmacies, 947 general practices and 3.8 million patients. METHODS: A total of 51 potential indicators were formulated, based on medicinal recommendations from the evidence-based guidelines of the Dutch College of General Practitioners and the corresponding recommendations from the Commission Pharmaceutical Help of the Health Care Insurance Board. These indicators were submitted to an expert panel to assess content validity. The panel assessment was analysed using the RAND-UCLA appropriateness method (RAM). Then, for the remaining indicators, it was assessed to what extent these could be used to determine the prescribing behaviour of GPs and the level to which this behaviour varies among GPs. This was done using a prescribing analyses and cost (PACT) database that was compiled from prescription databases from 379 pharmacies, with all prescriptions from 1,434 GPs over an entire year to 3.8 million patients. RESULTS: The panel considered 34 of the 51 potential indicators to be valid with respect to providing an adequate reflection of the central recommendations in the guideline and in terms of relevance with respect to health gain and/or efficiency. Of these 34 indicators, 20 revealed considerable differences in the prescribing behaviour of GPs. CONCLUSION: On the basis of existing general practice guidelines, 20 prescribing indicators could be formulated that were assessed by an expert panel to be sufficiently valid and which could also discriminate the prescribing behaviour of GPs as reflected in the prescription databases of pharmacies.

Databases, Factual↗
PubMed1986

A comparison of Doppler ultrasound waveform indices in the umbilical artery--II. Indices derived from the mean velocity and first moment waveforms.

Umbilical artery Doppler recordings in both normal pregnancy and cases of fetal growth failure were processed by computer. Representative waveforms for the maximum velocity, mean velocity and first moment were obtained after ensemble averaging and correction for thump filtering. The same set of indices, which included the AB ratio, pulsatility index, rising slope and relative flow rate index, were calculated for each of the waveforms. The results were compared to identify differences which might arise in clinical practice if a waveform other than the usual (maximum velocity) was used. The ratio of the mean to the maximum velocity, which gives an indication of the velocity profile, was shown to be very error prone. The reproducibility of the mean velocity and first moment indices was inferior to that of the maximum velocity indices. The results from the different waveforms were highly correlated for normals for most indices. However, in the growth retarded group there was a tendency for the mean velocity and first moment indices to classify as normal studies classified as abnormal by the maximum velocity index. The values of indices derived from the first moment waveform were generally larger than the maximum and mean velocity values. For the relative flow rate index, where results were often different to the general trend, the values were more nearly equal.

Blood Flow Velocity↗
PubMed1990

Regional indices of relative hepatic arterial perfusion from dynamic liver scintigraphy: the variability of indices and the use of parametric imaging.

Regional indices of relative arterial hepatic perfusion have been studied in 21 control subjects following dynamic radiocolloid scintigraphy of the liver (DLS). Three different indices have been calculated: the hepatic perfusion index (HPI); the hepatic arterial ratio (HAR) and the mesenteric fraction (MF). Three regions were defined in the upper, mid and lower right hepatic lobes and the three indices were calculated for each region. There was reasonable agreement between regional values of the same index with inter-regional correlation coefficients above 0.7 and standard errors in straight line fits of less than 0.093. There were significant regional differences for (1-MF) and HPI indices, but not for HAR. The index (1-MF) was calculated for each pixel and presented as a parametric image in 16 control subjects. The parametric images indicated the raised regional arterial indices due to overlying lung, right kidney and aorta. Parametric images may be of value to show the hepatic area free of significant overlying tissue and therefore available for analysis by DLS. However, the results suggest that the observed variability of single pixel indices limit the potential of parametric imaging for the localization of small focal lesions.

Humans↗
PubMed2005

Does the addition of functional status indicators to case-mix adjustment indices improve prediction of hospitalization, institutionalization, and death in the elderly?

BACKGROUND: Case-mix adjustment is widely used in health services research to ensure that groups being compared are equivalent on variables predicting outcome. There has been considerable development and testing of comorbidity indices derived from diagnostic codes recorded in administrative databases, but increasingly, the benefit of clinical information and patient reported ratings of health and functional status is being recognized. One type of information that is highly valued but has so far not been captured by administrative health databases is functional status indicators (FSI). OBJECTIVE: The purpose of this study was to estimate the extent to which prediction of health outcomes can be improved on by including information on functional status indicators (FSI). RESEARCH DESIGN: The data for the current study was obtained from a clustered randomized trial evaluating computerized decision support for managing drug therapy in the elderly, conducted from 1997 to 1998. A total of 107 primary care physicians participated in this trial and 6465 of their patients (51%) completed a generic health status measure-the SF-12-before the intervention. C statistics and R were used to compare the predictive value of sociodemographic factors, 2 comorbidity indices, and 11 FSI predictor variables derived from the SF-12 and coded (possible for 8) using the International Classification of Functioning (ICF). RESULTS: Using stepwise logistic regression, FSI, particularly limitation in stair climbing or doing moderate activities like housework, were found to be strong and independent predictors of all outcomes, even after controlling for sociodemographics and comorbidity. CONCLUSION: This study indicates that FSI provided as robust a prediction of health events as did complex comorbidity indices. Additionally, the ICF coding system provides a mechanism whereby information on FSI could be incorporated into administrative databases through the use of electronic health records that include a health or functional status measure.

Activities of Daily Living↗
PubMed2005

Testing of conductivity/calcium and rubidium/strontium ratios as indicators of the chemical stability of a river: comparison with a biological indicator.

It is customary to detect pollution in a water flow by monitoring the increase of sensitive elements concentrations (NH4+, PO4(3-), NO3-...). However, concentrations are dependent on the flow rate and these compounds are not conservative, implying a concentration decrease downstream leading to false negative diagnosis of pollution impact. The use of elemental ratios of conservative compounds should diminish these pitfalls. We then thought of the chi/Ca (conductivity/calcium) and Rb/Sr (rubidium/strontium) ratios as water chemical stability indicators to clearly identify and discriminate point from diffuse pollutions. This hypothesis has been tested on 12 brooks located in the basin of Lake Geneva, during 2 hydrological years. The results were compared to the observed land use of the watershed and a biological indicator: the Pollution Sensitivity Index (PSI). The PSI is calculated from diatom taxonomy and evaluates biological quality with a grade ranging from 0 to 20 (bad to excellent). The main results of the research can be summarized as follows. The pollution signal is observable far downstream of the pollution site. Both chi/Ca and Rb/Sr ratios are water quality indicators expressing the stability of water chemistry. They can both be used to detect diffuse and point pollution impact. These indicators provide complementary information: chi/Ca variations increase in case of point pollution; Rb/Sr variations increase when diffuse pollutions occur. The results obtained with the indicators chi/Ca and Rb/Sr agree with biological indicator and observation of the land use. chi/Ca and Rb/Sr ratios represent important tools to identify and discriminate point source pollution from diffuse pollution.

Biodiversity↗
PubMed1975

Decision-making in clinical practice: application of predictors, indicators and indices to the medical history obtained by a self-administered questionnaire.

A theoretical description of predictors, indicators, and health indices was presented in an earlier paper (Hall and Sebag, 1974). The application of predictors, indicators and health indices--including dynamic health indices--to anamnestic data obtained by a self-administered questionnaire is presented herein. Predictors and indicators showed a varying degree of 'decision-making significance' in the 122 questions examined. The health index distinguished between diagnosed individuals and those receiving no diagnosis(es). The dynamic health index was found to reflect changes in the health status of an individual over a period of time.

Decision Making↗
PubMed2001

The variability and repeatability of indices derived from the single-breath diagram for CO2 in horses with chronic obstructive pulmonary disease and the effect of lobelin hydrochloride on these indices.

Several indices of ventilatory heterogeneity can be identified from the volumetric capnogram and its graphic presentation, the single-breath diagram for CO2 (SBD-CO2). Physiologically based indices of pulmonary function (VTE, VCO2, FACO2, VDBohr% VDBohr%, VD/VTE, A1/A2) were calculated for healthy horses (group I, n = 5) and for horses with subclinical (group II, n = 7) or clinically manifest chronic obstructive pulmonary disease (COPD) (group III, n = 8) during tidal breathing and after medication with lobelin hydrochloride (Lobelin). We investigated the variability and repeatability of the lung function indices in healthy horses and in those with COPD both during tidal breathing and after administration of Lobelin, a centrally acting respiratory stimulant. In particular, we were interested in whether the discriminating ability of SBD-CO2-derived lung function indices would be increased between different patient groups after administration of Lobelin compared to those for the resting values. Of the indices studied, VTE, FACO, VDBohr% and A1/A2 appeared to be those with good to excellent repeatability in discriminating healthy horses from those with COPD. Stimulating respiration with Lobelin gave no advantage in the repeatability of the lung function indices or in differentiating between horses with different degrees of COPD.

Animals↗
PubMed2005

Indicated and non-indicated preterm delivery in twin gestations: impact on neonatal outcome and cost.

OBJECTIVE: To identify the etiology and impact of preterm delivery in twin gestations. STUDY DESIGN: Twin gestations delivered at 33.0 to 36.9 weeks were identified in a perinatal database, and categorized by indication for delivery. Deliveries were identified as indicated, or non-indicated (discretionary). Neonatal outcomes were measured by birth weight, length of stay, NICU admission, and ventilator utilization. Data were divided and analyzed by indicated or discretionary delivery, and gestational age at delivery. RESULTS: Analyzed were 3252 twin gestations (6504 infants), with 78% having indicated delivery. Of the 22% with discretionary delivery, nearly 40% required NICU admission. With each advancing week of gestation, there was a significant decrease in incidence of NICU admission and nursery days. CONCLUSION: The majority of preterm deliveries were indicated, though 22% were discretionary. It is vital to consider neonatal morbidity and costs related to gestational age when choosing discretionary delivery.

Adult↗
PubMed1999

Prediction of the Hiestand bonding indices of binary powder mixtures from single-component bonding indices.

A priori predictions of the bonding indices of binary powder mixtures from the single-component indices were attempted. The binary mixtures were classified according to the mechanism of deformation of the single-components as plastic-plastic, brittle-brittle, and plastic-brittle. When the components of a binary mixture consolidated by the same mechanism (plastic-plastic and brittle-brittle mixtures), a straight line could be fit to a plot of bonding index versus composition. This linearity indicates that the bonding index can be reliably estimated by interpolation between the two single-component bonding indices. When the mixtures were such that one component was brittle while the other was plastic, a linear function did not fit the data. For these cases, a second-degree polynomial equation could be fit to a plot of bonding index versus composition. A combination of multiple linear regression and trial and error was used to generate a single generalized equation. For pairs of compounds wherein each compound has a different compaction mechanism, this new equation appears to allow satisfactory predictions of the bonding indices of mixtures with varying compositions using only the single-component bonding indices.

Drug Compounding↗
PubMed2004

Nationwide continuous quality improvement using clinical indicators: the Danish National Indicator Project.

OBJECTIVE: In most countries there is no mandatory national system to track the quality of care delivered to the citizens. This paper describes an example of a national indicator project that aims at documenting and improving the quality of care nationwide. ANALYSIS: The Danish National Indicator Project was established in 2000 as a nationwide multidisciplinary quality improvement project. From 2000 to 2002, disease-specific clinical indicators and standards were developed for six diseases (stroke, hip fracture, schizophrenia, acute gastrointestinal surgery, heart failure, and lung cancer). Indicators and standards have been implemented in all clinical units and departments in Denmark treating patients with the six diseases, and participation is mandatory. All clinical units and departments receive their results every month. National and regional audit processes are organized to explain the results and to prepare implementation of improvements. All results are published in order to inform the public, and to give patients and relatives the opportunity to make informed choices. CONCLUSION: The surveillance of health care quality is greatly aided by the use of relevant quantitative indicators. This paper describes how it is possible to organize nationwide monitoring using clinical indicators.

Delivery of Health Care↗
PubMed2000

Dietary creatine supplementation does not affect some haematological indices, or indices of muscle damage and hepatic and renal function.

BACKGROUND: The use of creatine (Cr) as a nutritional supplement to aid athletic performance has gained widespread popularity among athletes. However, concerns have recently been expressed over potentially harmful effects of short and long term Cr supplementation on health. METHODS: Forty eight young healthy subjects were randomly allocated to three experimental protocols aimed at elucidating any potential health risks associated with five days (20 g/day) to nine weeks (3 g/day) of Cr supplementation. Venous blood samples were collected before and after periods of Cr supplementation and were analysed for some haematological indices, and for indices of hepatic, muscular, and renal dysfunction. FINDINGS: All measured indices were well within their respective normal range at all times. Serum creatinine concentration tended to be increased the day after Cr supplementation. However, values had returned to baseline six weeks after the cessation of supplementation. These increases were probably attributable to increased creatinine production rather than renal dysfunction. No indication of impairment to the haematological indices measured, hepatic function, or muscle damage was apparent after Cr supplementation. INTERPRETATION: These data provide evidence that there are no obvious adverse effects of acute or more chronic Cr supplementation on the haematological indices measured, nor on hepatic, muscle, and renal function. Therefore there is no apparent health risk associated with Cr supplementation to healthy people when it is ingested in quantities that have been scientifically proven to increase muscle Cr stores.

Adult↗
PubMed1988

[Indicator tubes with a noncylindrical form for indicator packing].

A new type of system is made for determination of chemical pollutants in the air--indicator tubes with noncylindrical indicator filling--a subject of invention. The effect of the noncylindrical form on the metrological characteristics of the indicator tubes is studied. The noncylindrical filling is a way to influence these characteristics without changing the chemical receipt. There are a number of advantages: increasing more of 10x the sensitivity; linearization of the logarithmic characteristics of the indication dusts; possibility to lay two contrary scales on the conical indicator tubes for sucking respectively from the one or the other side of the asymmetric indicator filling, thus realising opportunities for defining of very low or very high accuracy. A new type of sampling system is established in practice. The dependences are given graphically.

Acetaldehyde↗