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At least 685 records · Page 38Linked to original sources

PubMed1989

Alcohol and traffic safety: a sensitivity analysis of data from composite sources.

Risk factors associated with single-vehicle driver fatalities are explored in a sensitivity analysis of data from composite sources. Information on fatalities was taken from the Federal Accident Reporting System data base for 1976-1981. Characteristics of the driving population were given by the 1973 National Roadside Breath Testing Survey (Wolfe 1974). Using Bayes theorem and logistic regression analysis, the effect of changing driver characteristics on the probability of a fatality was explored. The method used is proposed for a case-control study in which the controls may not accurately represent the population from which the cases were drawn. Risk factors identified are generally in agreement with previous reports.

Accidents, Traffic↗

PubMed2005

Image analysis and data management of ELISPOT assay results.

The recent renaissance of enzyme-linked immunospot (ELISPOT) assays largely is the result of advances in image analysis. Information on the frequency of antigen-specific T-cells and also on the secretion rate of the individual cells is captured in spots generated using this technique. Although the overall assessment of ELISPOT results can be conducted visually, this is inevitably subjective, inaccurate, and cumbersome. In contrast, objective, and accurate measurements are fundamental to good science. Validated image analysis algorithms and procedures, therefore, have become critical for elevating the quality of ELISPOT assays results. As cytokine and granzyme B ELISPOT assays become the gold standard for monitoring antigen-specific T-cell immunity in clinical trials, the pressure increases to make ELISPOT analysis transparent, reproducible and tamperproof, complying with Good Laboratory Practice and Code for Federal Regulations Part 11 guidelines. In addition, ELISPOT assays in clinical and basic science settings frequently require high degrees of throughput, thus further raising the need for advanced data management and statistical analysis. The ImmunoSpot software portfolio has been specifically designed to meet all these needs, using the techniques described in this chapter.

Cytokines↗

PubMed1998

Cost analysis of surgical procedures for toxic nodular goiter.

Effective by January 1, 1993, the Federal Care Rate Regulation (Bundespflegesatzverordnung; BPflV) has started increased competition between hospitals by introducing performance related reimbursements. All three categories of flat payments, Fallpauschale (FP), Sonderentgelt (SE) and Budget-patient (BP), apply to toxic nodular goiter surgery, governed solely by the extent of thyroid resection. Unlike FP 2.01 and FP 2.02 which do not cover all surgical expenses, the BP flat rate provides a comparatively generous refund for total thyroidectomy. With the oncoming reduction of upper values for residual radioactivity, hospitalization will fall after radioiodine therapy, resulting in lower overall refunds. With this anticipated fall in reimbursement, refunds for radioactive therapy must be increased in the near future to ensure adequate financial compensation. Economic arguments for either therapeutic option will then cease to play a major role, allowing medical therapeutic considerations to prevail.

Costs and Cost Analysis↗

PubMed2006

Health system factors impacting on delivery of mental health services in Russia: multi-methods study.

OBJECTIVE: To evaluate how the regulatory environment and health system organisation, financing and provider payment systems influence the delivery of mental health services in the Sverdlovsk region of the Russian Federation. METHODS: A multi-methods study was conducted including analysis of routine data and key informant interviews supplemented by analysis of published literature, legal and regulatory documents, ministerial orders and reports. RESULTS: Mental health care services are still largely provided in hospitals, although the need for more community-based and rehabilitation services is widely recognised. Resource allocation and provider payment systems remain largely unchanged from Soviet times and favour large inpatient institutions, creating incentives for hospitals to maintain a large number of beds and staff. Community-based social services and human resources remain limited, especially in the areas of social work, housing support and vocational rehabilitation, but co-operation across sectors at local level is growing. CONCLUSION: In Russia, the pace of reform in the mental health system will be helped if financial resource allocation mechanisms and provider payment systems are also reformed, so that resources follow individuals regardless of where they are treated. Such major health system shifts can only be achieved through changes at the Federal level and require major political will. Additional transitional funding is also required to help develop the necessary alternative community-based services. The nature of mental health disorders mean that this is not a problem faced within the health system alone, greater attention needs to be placed also on how to maximise the cross sector benefits especially with the social protection and employment sectors.

Delivery of Health Care↗

PubMed1990

[High frequency long-term analysis and psychoanalytic practice. Utopia and reality].

On the basis of the prognostic study of psychotherapeutic treatment in the Federal Republic and of the evaluation of more than 1000 applications for insurance benefits submitted in the years from 1973 to 1983, it is suggested that high-frequency long-term analysis is the exception rather than the rule and that it is carried on almost exclusively by a small group of "privileged" therapists. The author asks what this implies for the definition of psychoanalysis and for daily treatment practice. Are therapists being trained for a kind of treatment that they will rarely or never practice? The author urges resumption of the discussion of theory and technique of psychoanalysis in which these questions will be considered.

Cost Control↗

PubMed1994

Evaluation of deoxyribonucleic acid ploidy and S-phase fraction as prognostic parameters in advanced epithelial ovarian carcinoma: a prospective study.

OBJECTIVE: Our goal was to study the prognostic value of deoxyribonucleic acid ploidy and S-phase fraction in advanced ovarian carcinoma. STUDY DESIGN: Prognostic factors for corrected survival were evaluated in a prospective study including 169 patients with stage III and IV ovarian cancer treated between 1985 and 1990. RESULTS: A total of 79% of the tumors were deoxyribonucleic acid aneuploid. Deoxyribonucleic acid aneuploidy was associated with grade of differentiation. S-phase fraction could be calculated in all deoxyribonucleic acid euploid tumors and 76% of the deoxyribonucleic acid aneuploid tumors. By multivariate analysis deoxyribonucleic acid ploidy, histologic type and grade, age, International Federation of Gynecology and Obstetrics stage, and amount of residual tumor were independent prognostic variables for corrected survival. On the basis of Cox regression a relative risk for the individual patient could be calculated. CONCLUSION: Deoxyribonucleic acid ploidy gives additive prognostic information and is a useful parameter for dividing patients with advanced ovarian cancer into risk groups for treatment decisions.

Adult↗

PubMed2005

Hospital service areas -- a new tool for health care planning in Switzerland.

BACKGROUND: The description of patient travel patterns and variations in health care utilization may guide a sound health care planning process. In order to accurately describe these differences across regions with homogeneous populations, small area analysis (SAA) has proved as a valuable tool to create appropriate area models. This paper presents the methodology to create and characterize population-based hospital service areas (HSAs) for Switzerland. METHODS: We employed federal hospital discharge data to perform a patient origin study using small area analysis. Each of 605 residential regions was assigned to one of 215 hospital provider regions where the most frequent number of discharges took place. HSAs were characterized geographically, demographically, and through health utilization indices and rates that describe hospital use. We introduced novel planning variables extracted from the patient origin study and investigated relationships among health utilization indices and rates to understand patient travel patterns for hospital use. Results were visualized as maps in a geographic information system (GIS). RESULTS: We obtained 100 HSAs using a patient origin matrix containing over four million discharges. HSAs had diverse demographic and geographic characteristics. Urban HSAs had above average population sizes, while mountainous HSAs were scarcely populated but larger in size. We found higher localization of care in urban HSAs and in mountainous HSAs. Half of the Swiss population lives in service areas where 65% of hospital care is provided by local hospitals. CONCLUSION: Health utilization indices and rates demonstrated patient travel patterns that merit more detailed analyses in light of political, infrastructural and developmental determinants. HSAs and health utilization indices provide valuable information for health care planning. They will be used to study variation phenomena in Swiss health care.

Catchment Area, Health↗

PubMed2007

Analysis of p53 protein expression levels on ovarian cancer tissue microarray using automated quantitative analysis elucidates prognostic patient subsets.

BACKGROUND: p53 protein is regarded as a valuable prognostic marker in cancer with a potential use as a molecular target. Here, we sought to determine the prognostic value of p53 in ovarian cancer using a novel method of compartmentalized in situ protein analysis. PATIENTS AND METHODS: A tissue array composed of 141 advanced stage ovarian cancers uniformly treated was constructed. For evaluation of p53 protein expression, we used an immunofluorescence-based method of automated in situ quantitative measurement of protein analysis (AQUA). RESULTS: High nuclear p53 expression levels were associated with better outcome for overall survival (OS) (P = 0.0023) and disease-free survival (P = 0.0338) at 5-years. High cytoplasmic p53 expression levels were associated with better outcome for OS (P = 0.0002). In multivariable analysis, high nuclear and high cytoplasmic p53 level with International Federation of Gynecology and Obstetrics (FIGO) stage were the most significant predictor variables for OS and high nuclear p53 level with FIGO stage were the significant predictor variables for disease-free survival. CONCLUSIONS: Assessment of the prognostic value of p53 protein levels using conventional immunohistochemistry is limited by the nonquantitative nature of the method. AQUA provides precise estimation of p53 protein levels and was able to elucidate the association of p53 protein levels and ovarian cancer prognosis.

Adult↗

PubMed1998

Physician retention in community and migrant health centers: who stays and for how long?

OBJECTIVES: This study used discrete-time survival analysis to estimate the tenure of primary care physicians in Community Health Centers (CHCs), to identify the changing risk of leaving Community Health Center employment as time passes, and to identify factors associated with a physician's likelihood of remaining in a Community Health Center. Because of dramatic differences in physician career trajectories, much of the focus was on differences between physicians with and without National Health Service Corps obligations. METHODS: Beginning with an administrative dataset at the Bureau of Primary Health Care that listed primary care physicians for each Community Health Center, the completeness and accuracy of the information provided were verified and an analytic database of all physicians working in those centers during a 21-month measurement window from January 1, 1990 through September 30, 1992 was constructed. The data included start and end dates, percent full-time equivalent status, and certain demographic characteristics. In addition, several data elements describing the Community Health Center were merged onto each physician record. These included urban or rural location, expenditure level, productivity, and federal grade. Through the use of discrete-time survival analysis, it was possible to include in the analytic sample all 2,654 physicians who worked during the period, even those who started working before January 1, 1990 and those who were still working on September 30, 1992. Survivor functions were estimated showing the proportion of physicians remaining after each quarter of their tenure (ie, after the fourth quarter of work, after the 12th quarter of work, etc). In addition, hazard functions were estimated showing the risk that a physician who had worked through the end of one quarter would leave during the following quarter. Finally, multivariate analysis demonstrated the relation of certain physician and center characteristics to the likelihood of the physician's leaving the center during each quarter. RESULTS: The median tenure of primary care physicians in Community Health Centers was approximately 3 years regardless of whether or not the physician had a National Health Service Corps obligation. But the career trajectories for the two groups of physicians varied dramatically. Most physicians left on or about their anniversary date, probably because it coincided with the end of their contract, but the effect was much more pronounced for National Health Service Corps physicians than for non-National Health Service Corps physicians. By the end of 5 years, approximately 36% of physicians who started without an National Health Service Corps obligation were still working compared with only approximately 17% of those with an National Health Service Corps obligation. CONCLUSIONS: The study demonstrates the value of discrete-time survival analysis in addressing questions related to the tenure of primary care physicians in Community Health Centers, making it possible to use data from physicians whose Community Health Center careers began before or ended after a give measurement window. Second, the study measured primary care physician tenure, providing center directors with a yard-stick against which to compare their own center's performance. Finally, the data provided some help in trying to explain differences in the propensity to stay or leave employment in Community Health Centers.

Career Mobility↗

PubMed2005

Resolving clinicians' queries across a Grid's infrastructure.

OBJECTIVES: The past decade has witnessed order of magnitude increases in computing power, data storage capacity and network speed, giving birth to applications which may handle large data volumes of increased complexity, distributed over the internet. METHODS: Medical image analysis is one of the areas for which this unique opportunity likely brings revolutionary advances both for the scientist's research study and the clinician's everyday work. Grids [1] computing promises to resolve many of the difficulties in facilitating medical image analysis to allow radiologists to collaborate without having to co-locate. RESULTS: The EU-funded MammoGrid project [2] aims to investigate the feasibility of developing a Grid-enabled European database of mammograms and provide an information infrastructure which federates multiple mammogram databases. This will enable clinicians to develop new common, collaborative and co-operative approaches to the analysis of mammographic data. CONCLUSION: This paper focuses on one of the key requirements for large-scale distributed mammogram analysis: resolving queries across a grid-connected federation of images.

Algorithms↗

PubMed1988

[Fertility life tables].

"Three tables for measuring human fertility are presented. The first, the Parity-Fertility-Life-Table, includes the intensity of fertility only. The second table, the Marriage-Duration-Fertility-Life-Table, bases on the Parity-Fertility-Life-Table and measures the tempo of fertility altogether. The third table, the Birth-Interval-Fertility-Life-Table, completes the Marriage-Duration-Fertility-Life-Table in considering the point of time, at which the last parity is reached." The methods are illustrated using official data for the Federal Republic of Germany. (SUMMARY IN ENG)

Birth Intervals↗

PubMed2000

Domestic AIDS vaccine trials: addressing the potential for social harm to the subjects of human experiments.

In 1998, the FDA approved the first large-scale human trials of a candidate AIDS vaccine in our nation's history. While the legal issues raised by these trials are manifold, the academic literature has focused almost exclusively on the potential for mass tort liability and the resulting hesitancy of biotech and pharmaceutical firms to enter the field. This Comment argues that another issue of vital concern demands attention: the potential for social harm to the human subjects of AIDS vaccine trials. After providing an overview of the current epidemiology of HIV/AIDS and explaining why a safe, effective AIDS vaccine represents the best way to control the pandemic, this Comment analyzes the scientific and social obstacles to production of such a vaccine. In order to know whether a candidate AIDS vaccine is truly effective, researchers will have to test the product in HIV-negative volunteers at high risk of infection. Since these volunteers may subsequently test positive for HIV on standard blood tests, they will be vulnerable to discrimination on that basis in such areas as employment, insurance, immigration, and incarceration. Moreover, by participating in vaccine trials, volunteers will be marking themselves as people at high risk of HIV infection, another basis for disparate treatment. Researchers have suggested that federal disability discrimination law may afford protection against research-related social harms. Through close analysis of the Americans with Disabilities Act of 1990 and the Supreme Court's decision in Bragdon v. Abbott, this Comment demonstrates that optimistic reliance on federal disability law is misplaced. The unique issues raised by domestic AIDS vaccine trials must be addressed in their own right. The Comment accordingly concludes with a broad range of legislative and regulatory proposals to protect trial participants and advance the AIDS vaccine research agenda.

Animals↗

PubMed1990

Transmission of a Gaussian scanning beam through circular, square, and slit apertures: Part II. Experimental results for transmission through a circular aperture.

To perform an analysis of the hazards associated with scanned laser radiation to determine compliance with either federal or user standards, it is usually necessary to determine the amount of energy entering a specified aperture. A mathematical model has recently been developed that may simplify the hazard analysis. Experimental data and the mathematical model were compared for stationary and scanning Gaussian laser beams transmitted through a stationary 7-mm-diameter circular aperture, representing the dilated pupil of the human eye. Data were obtained for three values of laser beam diameter. The data and the mathematical model were found to agree within the estimated experimental error when the laser beam was concentric with the aperture, the situation typically encountered in compliance measurements. For two of the three laser beam diameters studied, as the eccentricity of the laser beam with respect to the center of the aperture was increased, the difference between the data and the mathematical model was found to increase. At the higher degrees of eccentricity, the percentage errors were shown to be highly sensitive to the errors in the determination of relative position.

Energy Transfer↗

PubMed2004

Efficiency of federal hospitals in the United States.

This study evaluates the technical efficiency of federal hospitals in the United States using a variable returns to scale, input-oriented, data envelopment analysis (DEA) methodology. Hospital executives, health care policy-makers, taxpayers, and other stakeholders, benefit from studies that improve the efficiency of federal hospitals. Data for 280 federal hospitals in 1998 and 245 in 2001 were analyzed using DEA to measure hospital efficiency. Results indicate overall efficiency in federal hospitals improved from 68% in 1998 to 79% in 2001. However, based upon 2001 spending of $42.5 billion for federal hospitals potential savings of $2.0 billion annually are possible through more efficient management of resources. From a policy perspective, this study highlights the importance of establishing more specific policies to address inefficiency in the federal health care industry.

Efficiency, Organizational↗

PubMed1988