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PubMedDate not supplied

The relationship between primary care, income inequality, and mortality in US States, 1980-1995.

OBJECTIVES: This study tests the robustness of the relationships between primary care, income inequality, and population health by (1) assessing the relationship during 4 time periods-1980, 1985, 1990 and 1995; (2) examining the independent effect of components of the primary care physician supply; (3) using 2 different measures of income inequality (Robin Hood index and Gini coefficient); and (4) testing the robustness of the association by using 5-year time-lagged independent variables. DATA SOURCES/STUDY SETTING: Data are derived from the Compressed Mortality Files, the US Department of Commerce and the Census Bureau, the National Center for Health Statistics, the Centers for Disease Control and Prevention, and the American Medical Association Physician Master File. The unit of analysis was the 50 US states over a 15-year period. STUDY DESIGN: Ecological, cross-sectional design for 4 selected years (1980, 1985, 1990, 1995), and incorporating 5-year time-lagged independent variables. The main outcome measure is age-standardized, all-cause mortality per 100,000 population in all 50 US states in all 4 time periods. DATA COLLECTION/EXTRACTION METHODS: The study used secondary data from publicly available data sets. The CDC WONDER/PC software was used to obtain mortality data and directly standardize them for age to the 1980 US population. Data used to calculate the income inequality measure came from the US census population and housing summary tapes for the years 1980 to 1995. Counts of the number of households that fell into each income interval along with the total aggregate income and the median household income were obtained for each state. The Gini coefficient for each state was calculated using software developed for this purpose. RESULTS: In weighted multivariate regressions, both contemporaneous and time-lagged income inequality measures (Gini coefficient, Robin Hood Index) were significantly associated with all-cause mortality (P <.05 for both measures for all time periods). Contemporaneous and time-lagged primary care physician-to-population ratios were significantly associated with lower all-cause mortality (P <.05 for all 4 time periods), whereas specialty care measures were associated with higher mortality (P <.05 for all time periods, except 1990, where P <.1). Among primary care subspecialties, only family medicine was consistently associated with lower mortality (P <.01 for all time periods). CONCLUSIONS: Enhancing primary care, particularly family medicine, even in states with high levels of income inequality, could lead to lower all-cause mortality in those states.

Cross-Sectional Studies↗

PubMed1995

Stereotactic radiosurgery for glioblastoma: a final report of 31 patients.

From February 1989 to December 1992, 31 patients who presented with an initial pathological diagnosis of glioblastoma multiforme underwent tumor debulking or biopsy, stereotactic radiosurgery, and standard radiation therapy as part of their primary treatment. Presenting characteristics in the 22 men and nine women included a median age of 57 years, Karnofsky Performance Scale score median of 80, and median tumor volume of 16.4 cm3. Stereotactic radiosurgery delivered a central dose of 15 to 35 Gy with the isocenter location, collimator size, and beam paths individualized by means of three-dimensional software developed at the University of Wisconsin. The peripheral isodose line varied from 40% to 90% with a median of 72.5% and a mode of 80%. The mean follow-up period was 12.84 months with a median of 9.5 months. Statistical analysis was performed using Kaplan-Meier analysis and log-rank comparison of risk factor groups. The parameters of age, initial Karnofsky Performance Scale score, and biopsy were significantly different in patient survival from debulking; but no difference was noted between single and multiple isocenters and patterns of steroid requirement. Radiographic recurrences were divided by location into the following categories: central (within central stereotactic radiosurgery dose), 0; peripheral (within 2 cm of central dose), 19; and distant (> 2 cm), 4. There is no evidence of recurrence in five surviving patients. Actuarial 12-month survival was 37%, with a median survival of 9.5 months. These values are similar to previous results for surgery and standard radiotherapy alone. The results suggest that the curative value of radiosurgery is significantly limited by peripheral recurrences.

Actuarial Analysis↗

PubMed1997

Circumferential profiles of peripapillary surface height with confocal scanning laser ophthalmoscopy.

The purpose of this study was to compare the circumferential profiles of relative peripapillary retinal surface height (RPSH) between normal and glaucoma, with a confocal scanning laser ophthalmology (CSLO), and to examine the ability of the mean height to distinguish glaucoma from normal. Fifty-three patients with open-angle glaucoma and forty-three normal subjects matched for age, race and refractive error were studied. To extract circumferential profiles, we developed software to quantify RPSH from images obtained with a CSLO (Heidelberg Retina Tomograph (HRT), Heidelberg Engineering, Germany, Software: IR1-V1.11) outside the optic disc margin every 50 microns. Mean heights from circumferential profiles were calculated and compared between normal and glaucoma. Receiver operating characteristic (ROC) curves were used to evaluate sensitivity and specificity of the mean height to discriminate normal from glaucoma subjects. T he average (+/- SD) visual field mean deviation in the glaucoma group was -4.8 +/- 3.4dB. The average height of each circumference increased from the disc margin to 250 microns away in both normal and glaucoma subjects. There were statistically significant differences for the mean height (P < 0.001) between the two groups. The largest difference between normal and glaucoma was found in the inferior sector compared with the other sectors (p < 0.001). The sensitivity, specificity and diagnostic precision of the mean height were 83%, 67% and 76%, respectively. The mean height from the circumferential profiles of RPSH can be used as a useful marker to identify early glaucoma.

Exfoliation Syndrome↗

PubMed2022

Flnc: Machine Learning Improves the Identification of Novel Long Noncoding RNAs from Stand-Alone RNA-Seq Data.

Long noncoding RNAs (lncRNAs) play critical regulatory roles in human development and disease. Although there are over 100,000 samples with available RNA sequencing (RNA-seq) data, many lncRNAs have yet to be annotated. The conventional approach to identifying novel lncRNAs from RNA-seq data is to find transcripts without coding potential but this approach has a false discovery rate of 30-75%. Other existing methods either identify only multi-exon lncRNAs, missing single-exon lncRNAs, or require transcriptional initiation profiling data (such as H3K4me3 ChIP-seq data), which is unavailable for many samples with RNA-seq data. Because of these limitations, current methods cannot accurately identify novel lncRNAs from existing RNA-seq data. To address this problem, we have developed software, Flnc, to accurately identify both novel and annotated full-length lncRNAs, including single-exon lncRNAs, directly from RNA-seq data without requiring transcriptional initiation profiles. Flnc integrates machine learning models built by incorporating four types of features: transcript length, promoter signature, multiple exons, and genomic location. Flnc achieves state-of-the-art prediction power with an AUROC score over 0.92. Flnc significantly improves the prediction accuracy from less than 50% using the conventional approach to over 85%. Flnc is available via GitHub platform.

RNA-seq↗

PubMed2004

Effect of integrated traditional Chinese and Western medicine on SARS: a review of clinical evidence.

AIM: To assess the possible effect of integrated traditional Chinese and Western medicine on severe acute respiratory syndromes. METHODS: The current available randomized controlled trials of integrated traditional Chinese and Western medicine on SARS were identified through systematically searching literature in any languages or any types of publications. Additional studies of gray literature were also collected. The quality of studies was evaluated by two investigators independently based largely on the quality criteria specified CONSORT. Statistical analysis of the results was performed using RevMan 4.2.0 software developed by the Cochrane Collaboration. RESULTS: Six studies (n = 366) fulfilling the inclusion criteria were found, of which the quality of one study was graded as B, the remaining five were graded as C. Two studies were performed with meta-analysis, the other four studies existed some heterogeneity for which meta-analysis could not be performed, a significant effect on lung infiltrate absorption was found in the treatment groups of these two studies (RR 6.68, 95% CI (2.93, 15.24), P<0.01), there was no significant differences between the mortality (RR 0.86, 95% CI (0.22, 3.29), P = 0.82) and the average dosage of corticosteroid (WMD -39.65, 95% CI (-116.84, 37.54), P = 0.31). The other three studies also showed significant differences in infiltrate absorption, including national drug No. 2. 3. 4 in combination with Western medicine (RR 5.45, 95% CI (1.54, 19.26)), compound formulas NO. 1 combined with Western medicine (WMD 0.24, 95% CI (0.02, 0.46)), compound formulas combined with Western medicine (RR 8.06, 95% CI (0.40, 163.21)). Kangfeidian No.4 in combination with Western medicine had no significant effect on symptom improvement such as loss of dyspnea and cough (RR 1.50, 95%CI (0.41, 5.43)) and (RR 1.29, 95%CI (0.30, 5.43)). CONCLUSION: Integrated traditional Chinese and Western medicines has some positive effects on lung infiltrate absorption in SARS patients, and is recommended as an adjunct treatment for SARS. However, its effect on SARS requires further careful study due to limited available randomized control trials.

Antiviral Agents↗

PubMedDate not supplied

Structural equation modeling: a primer for health behavior researchers.

OBJECTIVE: To introduce the state of the art of structural equation modeling (SEM). METHOD: This primer is organized in a manner allowing readers to review any one of 5 freestanding sections. RESULTS: SEM maintains several advantages over regression and other multivariate techniques. Through a 2-step modeling process, SEM strengthens research by allowing for the specification of complex, theory-driven models that can be tested with empirical data. Although use of SEM alone is not a magic solution, new software developments provide users with unparalleled flexibility for improving research. CONCLUSION: SEM must be thrust into the daily vocabulary and routine practice of health behavior researchers.

Health Behavior↗

PubMed2004

[Development of automatic verification system for portal image in radiotherapy].

The current method of verification for external beam radiation therapy visually compares a simulation image with a portal image. However, because this method depends largely upon the observer's experience, it sometimes results in inter-observer differences. In this study, we developed software to measure atomatically the quantitative difference between the simulation image and portal image using an image-analysis method. The feasibility of this software was evaluated on a rectangular field in the pelvic region. We took 12 simulation images of a pelvic phantom, setting 4 different field shapes on each of 3 isocenters. We then obtained 84 portal images setting 7 known distances from each of the 12 simulation images. Using this software, the direction of shift was detected correctly, and the distance of shift was detected correctly to within less than 3 mm. We consider that this software could be a useful method of verification.

Computer Simulation↗

PubMed1998

[Optimal use of MRI mammography from the economic viewpoint].

With the introduction of the contrast agent gadolinum DTPA there were hopes that "MRM" would prove to be the investigatory technique that would largely solve the problems of breast diagnostics. However, after the early years of acceptance, the new method of investigation became a subject of controversy. Nonetheless, MRM today occupies a recognized place in diagnostics for certain indications. It is still true, however, that reliable use of this procedure requires a great deal of experience, since there is a relatively large area of overlap between benign and malignant tumors. Further, the costs are significantly higher than those for conventional methods of investigation. New studies that have been conducted at the Charité, Campus Virchow Medical Center in Berlin, suggest that, if one takes the relevant indications into account, MRM can be economic and contribute significantly to cost reduction. Application of a newly developed software package has shown that the good discrimination in a suspect area resulting from contrast agent enhancement makes possible a reliable differentiation between malignant and benign tissue changes. A further result was that, when certain boundary conditions are satisfied, a contrast agent bolus of 0.1 mmol/kg BW is sufficient, making a double dose (0.2 mmol/kg BW) unnecessary.

Breast Neoplasms↗

PubMedDate not supplied

Physician services: income projection (PSIP) under Medicare reform.

By now, every administrator in America is well aware of the resource-based relative value scale (RBRVS) now being used for physician reimbursement. Unfortunately, many administrators are unable to predict its effects on their organization. It was for this reason, writes Mary Jo Hartwell, that the Center for Research in Ambulatory Health Care Administration developed software in 1990 to help physicians and administrators determine the potential impact of RBRVS on their group.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1994

Tapping in to new technology. Close links to patients at home.

This telecommunications system contacts home care patients automatically for followup using clinically developed software and a standard touch-tone phone. This system could help control costs by allowing health professionals to monitor patients' progress without unnecessary visits.

Home Care Services↗

PubMed1997

Enhanced ABC costing for hospitals: directed expense costing.

Space limitations do not allow a complete discussion of all the topics and many of the obvious questions that the preceding brief introduction to directed expense costing probably raised in the reader's mind. These include how errors in accounting practices like posting expenses to the wrong period are handled; and how the system automatically adjusts costs for expenses benefiting several periods but posted to the acquisition month. As was mentioned above, underlying this overtly simple costing method are a number of sophisticated and sometimes complex processes that are hidden from the normal user and designed to automatically protect the integrity and accuracy of the costing process. From a user's viewpoint, the system is straightforward, understandable, and easy to use and audit. From a software development perspective, it is not quite that effortless. By using a system that is understood by all users at all levels, these users can now communicate with each other in a new and effective way. This new communication channel only occurs after each user is satisfied as to the overall costing quality achieved by the process. However, not all managers or physicians are always happy that the institution is using this "understandable" cost accounting system. During one of the weekly meetings of a hospital's administrative council, complaints from several powerful department heads concerning the impact that the use of cost data was having on them were brought up for discussion. In defending the continued use of the system, one vice president stated to the group that cost accounting does not get any easier than this, or any less expensive, or any more accurate. The directed expense process works and works very well. Our department heads and physicians will have to come to grips with the accountably it provides us to assess their value to the hospital.

Accounting↗

PubMedDate not supplied

New technology considerations in system selection.

To get the most from their investment, persons choosing hospital information systems today should keep in mind technological trends affecting future system standards. This article describes specific hardware and software developments and outlines factors increasing the need for system flexibility and integration.

Computers↗

PubMed1985

EMS performance management.

Our development of a performance analysis system requires that we provide not only great detail about an EMS system's dynamic needs but also that we develop a means to manage our minute to minute resources. We thus had to develop software that was complementary in nature. These applications can be used together or by themselves to give an EMS provider tools for getting the maximum performance from their system.

Computers↗

PubMed1987

Pharmacy automation considerations.

The three major areas of concern which impact the automation of today's hospital pharmacy send a clear message to vendors. The message is that vendors need to offer an integrated pharmacy management system on the hospital's central computer to offer significant department functionality. The system must have a consistent fit into the technological direction of information systems at the hospital. Such a system provides the ability to gather and access information for numerous hospital departments to support the delivery of high quality clinical care and to support the decision-making process. This provides the hospital the best chance to compete effectively. The hospital's objective must continue to be the main thrust of software development efforts.

Computers↗

PubMed1976

ECDIN, an EC data bank for environmental chemicals.

All environmentally relevant information is computer stored for each organic chemical manufactured in quantities above 1.000 tons per year (whether it is considered as potentially toxic or not), known toxic chemicals (independently of their production figures) and certain classes of inorganic chemicals. The main data fields ("attributes" for each chemical) are: 1. substance identification and physicochemical data; 2. production and use data; 3. handling, transportation, and disposal; 4. environmental involvement (breakdown under biotic and abiotic conditions, average concentrations in environmental matrices); 5. biological effects and toxicity; 6. protection standards, administrative and regulatory data. Structure and substructure codification permits screening for substances with similar structures and coupling to GC-MS-computer analysis units with full or approximative structure outputs. A pilot project has been started permitting queries via direct and inverted file. It will include all available information on a limited number of compounds (some 5.000) from different chemical and use classes. The further software development foresees automatic indexing, automatic encoding of formatted data, automatic query formulation and search on a probabilistic basis for natural-language source data. Easy data flow is ensured by a networking between the central unit at the EC research Centre in Ispra (Italy) and specialised national data centres (ECDIN = European Chemicals Data and Information Network).

Chemical Industry↗

PubMed1999

Predicting composition of leg sections with anthropometry and bioelectrical impedance analysis, using magnetic resonance imaging as reference.

Magnetic resonance imaging (MRI) was used to evaluate and compare with anthropometry a fundamental bioelectrical impedance analysis (BIA) method for predicting muscle and adipose tissue composition in the lower limb. Healthy volunteers (eight men and eight women), aged 41 to 62 years, with mean (S.D.) body mass indices of 28.6 (5.4) kg/m2 and 25.1 (5.4) kg/m2 respectively, were subjected to MRI leg scans, from which 20-cm sections of thigh and 10-cm sections of lower leg (calf) were analysed for muscle and adipose tissue content, using specifically developed software. Muscle and adipose tissue were also predicted from anthropometric measurements of circumferences and skinfold thicknesses, and by use of fundamental BIA equations involving section impedance at 50 kHz and tissue-specific resistivities. Anthropometric assessments of circumferences, cross-sectional areas and volumes for total constituent tissues matched closely MRI estimates. Muscle volume was substantially overestimated (bias: thigh, -40%; calf, -18%) and adipose tissue underestimated (bias: thigh, 43%; calf, 8%) by anthropometry, in contrast to generally better predictions by the fundamental BIA approach for muscle (bias: thigh, -12%; calf, 5%) and adipose tissue (bias: thigh, 17%; calf, -28%). However, both methods demonstrated considerable individual variability (95% limits of agreement 20-77%). In general, there was similar reproducibility for anthropometric and fundamental BIA methods in the thigh (inter-observer residual coefficient of variation for muscle 3.5% versus 3.8%), but the latter was better in the calf (inter-observer residual coefficient of variation for muscle 8.2% versus 4.5%). This study suggests that the fundamental BIA method has advantages over anthropometry for measuring lower limb tissue composition in healthy individuals.

Adipose Tissue↗

PubMed1999

New on-line methods for analysis of walking foot pressures in diabetic neuropathy.

In this paper, studies are performed on a large number of diabetic patients belonging to different classes, using new on-line foot pressure parameters, i.e. normalized peak pressure (NPP) and pressure contact ratio (PCR), which include effects of the weight of the subject, velocity of walking and duration of high pressures in any region of the foot. A statistical study of the mean maximum value of these parameters in different plantar areas of the feet, for different classes of diabetic subjects, indicates distinguishing trends and hence could aid the clinician in better diagnosis and therapy planning. The NPP and PCR transforms calculated on-line (using specially developed software) help the clinician to quickly determine the heavily loaded foot areas that are potential sites of ulceration in insensitive feet and take the necessary action to prevent further damage to the foot sole.

Diabetes Mellitus↗

PubMed1998

Quantitative and ultrastructural analysis of the chondriome in ovogenesis and embryogenesis of the sea urchin Paracentrotus lividus.

The dynamics of chondriome in the ovogenesis of the sea urchin Paracentrotus lividus was studied. Growing oocytes 20-30, 50-60 and 90-100 microm in diameter ("small", "medium-sized" and "large", respectively) and mature eggs were used for the ultrastructural and stereological analysis of mitochondria. Linear parameters of mitochondria (length and thickness) were measured on 3-D reconstructions of serial ultrathin sections using the software developed in the laboratory. The following transformations of chondriome structure were shown to occur during ovogenesis: (1) the number of mitochondria (MT) increases with the growth of cytoplasmic compartment; (2) the modal length of MT increases from 0.5 microm in small oocytes to 1 microm in large ones and decreases again to 0.5 microm in the egg; this process is accompanied by changes in the relative number of spherical MT which decreases in medium-sized oocytes and subsequently rises again in the egg; (3) in medium-sized oocytes, dumbbell-shaped MT appear first, the number of these MT reaching the maximum to the stage of large oocytes. In mature eggs, the dumb-bell-shaped MT are absent; (4) in small and medium-sized oocytes, the orthodox conformation of MT is observed, in contrast to MT with a condensed matrix in large oocytes and eggs; (5) in mature eggs, mitochondrial clusters containing 10 to 20 MT of various size are formed. Based on the data obtained, we suggested that during ovogenesis of the sea urchin, specific differentiation of the chondriome is induced which leads to the increase in the quantity of MT via multiple division acts, while restricting the MT growth and variability of their shape.

Animals↗