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PubMed2005

Spatial patterning of water quality in Biscayne Bay, Florida as a function of land use and water management.

An objective classification analysis was performed on a water quality data set from 25 sites collected monthly during 1994-2003. The water quality parameters measured included: TN, TON, DIN, NH4+, NO3-, NO2-, TP, SRP, TN:TP ratio, TOC, DO, CHL A, turbidity, salinity and temperature. Based on this spatial analysis, Biscayne Bay was divided into five zones having similar water quality characteristics. A robust nutrient gradient, driven mostly by dissolved inorganic nitrogen, from alongshore to offshore in the main Bay, was a large determinant in the spatial clustering. Two of these zones (Alongshore and Inshore) were heavily influenced by freshwater input from four canals which drain the South Dade agricultural area, Black Point Landfill, and sewage treatment plant. The North Bay zone, with high turbidity, phytoplankton biomass, total phosphorus, and low DO, was affected by runoff from five canals, the Munisport Landfill, and the urban landscape. The South Bay zone, an embayment surrounded by mangrove wetlands with little urban development, was high in dissolved organic constituents but low in inorganic nutrients. The Main Bay was the area most influenced by water exchange with the Atlantic Ocean and showed the lowest nutrient concentrations. The water quality in Biscayne Bay is therefore highly dependent of the land use and influence from the watershed.

Alkaline Phosphatase↗

PubMed1998

Use of Ergonomics as a Quality Improvement Tool in a Manual Assembly Task.

This study attempted to identify a direct relationship between the design characteristics of a manually-assembled product, exposure to work-related ergonomic risk factors, and improvement in product quality. The study considered (a) Accessibility (ease of approach) and Guidance (ease of alignment and positioning) as Design Variables, (b) Shoulder Abduction, Trunk Lateral Flexion, Rate-Normalized Percentage of Maximal Voluntary Contraction (%MVC) of the Wrist Flexors, Wrist Extensors, and Deltoids, and Frequency of Attachment as Ergonomics Variables, and (c) Percentage of Attachment Too Loose, Too Tight, and Misaligned as Quality Variables. Postural data, surface EMG data, and quality data were collected from 10 participants performing four 10-min repetitive manual assembly tasks with plastic threaded nuts, bolts, flat parts, and open-box parts. Unobstructed accessibility of manually-assembled parts was associated with decreased exposure to awkward trunk posture, decreased activity of the wrist flexors and extensors, increased frequency of repetitive motion, and a decrease in the tendency to attach parts too loosely. Accessibility had no effect on misalignment defects as measured. Part guidance decreased the number of parts attached too tightly and aided in increasing the rate of assembly of parts when there was unobstructed access to parts.

Journal Article↗

PubMed1986

Assessment of spermatozoal function using dual fluorescent staining and flow cytometric analyses.

Spermatozoa from bulls, boars, dogs, horses, mice, and men were examined using a fluorogenic stain consisting of the membrane-permeant substrate carboxyfluorescin diacetate (CFDA) and the relatively membrane-impermeant nuclear stain propidium iodide (PI). Three distinct populations of spermatozoa were discernible in samples from each species upon microscopic examination. Individual spermatozoa, presumed to be viable because of their motility, retained products of the fluorescein chromophore throughout the cell. A second population of spermatozoa in which the nuclei stained red with PI retained the green fluorescein fluorophore mainly in the acrosome. A third population, presumed to be degenerate spermatozoa, possessed only red fluorescent nuclei. These populations were quantified using dual parameter flow cytometry in 14 samples of cryopreserved bovine spermatozoa for which fertility and seminal quality data were available. Flow cytometric analyses were highly correlated with other seminal quality measurements. Sequential flow cytometric analyses provided the ability to rapidly quantitate changes in specific fluorescently stained populations. The ability to make rapid quantitative measurements should allow development of new and presumably more reliable information on the functional aspects of spermatozoa.

Acrosome↗

PubMedDate not supplied

The reliability and validity of birth certificates.

OBJECTIVES: To summarize the reliability and validity of birth certificate variables and encourage nurses to spearhead data improvement. DATA SOURCES: A Medline key word search of reliability and validity of birth certificate, and a reference review of more than 60 articles were done. STUDY SELECTION: Twenty-four primary research studies of U.S. birth certificates that involved validity or reliability assessment. DATA EXTRACTION: Studies were reviewed, critiqued, and organized as either a reliability or a validity study and then grouped by birth certificate variable. DATA SYNTHESIS: The reliability and validity of birth certificate data vary considerably by item. Insurance, birthweight, Apgar score, and delivery method are more reliable than prenatal visits, care, and maternal complications. Tobacco and alcohol use, obstetric procedures, and delivery events are unreliable. Birth certificates are not valid sources of information on tobacco and alcohol use, prenatal care, maternal risk, pregnancy complications, labor, and delivery. CONCLUSIONS: Birth certificates are a key data source for identifying causes of increasing U.S. infant mortality but have serious reliability and validity problems. Nurses are with mothers and infants at birth, so they are in a unique position to improve data quality and spread the word about the importance of reliable and valid data. Recommendations to improve data are presented.

Alcohol Drinking↗

PubMed2006

WHO Child Growth Standards based on length/height, weight and age.

AIM: To describe the methods used to construct the WHO Child Growth Standards based on length/height, weight and age, and to present resulting growth charts. METHODS: The WHO Child Growth Standards were derived from an international sample of healthy breastfed infants and young children raised in environments that do not constrain growth. Rigorous methods of data collection and standardized procedures across study sites yielded very high-quality data. The generation of the standards followed methodical, state-of-the-art statistical methodologies. The Box-Cox power exponential (BCPE) method, with curve smoothing by cubic splines, was used to construct the curves. The BCPE accommodates various kinds of distributions, from normal to skewed or kurtotic, as necessary. A set of diagnostic tools was used to detect possible biases in estimated percentiles or z-score curves. RESULTS: There was wide variability in the degrees of freedom required for the cubic splines to achieve the best model. Except for length/height-for-age, which followed a normal distribution, all other standards needed to model skewness but not kurtosis. Length-for-age and height-for-age standards were constructed by fitting a unique model that reflected the 0.7-cm average difference between these two measurements. The concordance between smoothed percentile curves and empirical percentiles was excellent and free of bias. Percentiles and z-score curves for boys and girls aged 0-60 mo were generated for weight-for-age, length/height-for-age, weight-for-length/height (45 to 110 cm and 65 to 120 cm, respectively) and body mass index-for-age. CONCLUSION: The WHO Child Growth Standards depict normal growth under optimal environmental conditions and can be used to assess children everywhere, regardless of ethnicity, socio-economic status and type of feeding.

Body Height↗

PubMed2006

Measuring population health: a review of indicators.

This article reviews the historical development of population health indicators. We have long known that environmental, socioeconomic, early life conditions, individual actions, and medical care all interact to affect health. Present quantitative reporting on the impact of these factors on population health grew out of Bills of Mortality published in the 1500s. Since then, regular censuses, civil registration of vital statistics, and international classification systems have improved data quality and comparability. Regular national health interview surveys and application of administrative data contributed information on morbidity, health services use, and some social determinants of health. More recently, traditional health databases and datasets on "nonhealth" sector determinants have been linked. Statistical methods for map-making, risk adjustment, multilevel analysis, calculating population-attributable risks, and summary measures of population health have further helped to integrate information. Reports on the health of populations remain largely confined to focused areas. This paper suggests a conceptual framework for using indicators to report on all the domains of population health. Future ethical development of indicators will incorporate principles of justice, transparency, and effectiveness.

Canada↗

PubMed2004

Clarity and diagnostic quality of digitized conventional intraoral radiographs.

OBJECTIVES: To compare digital images of conventional radiographs with the original radiographs for perceived clarity of endodontic files, periapical lesions and carious lesions, and to establish the diagnostic value of the digital images. METHODS: Four groups of ten radiographs were used: standardized bitewings demonstrating carious lesions, periapical radiographs of apical lesions, periapical radiographs showing endodontic files of various sizes at working length, and standardized periapical radiographs with size 08 files at working length. Radiographs were photographed using an Olympus C 2500-L digital camera and a Nikon D1X digital camera and were scanned using a Nikon Supercoolscan 4000 ED film/slide scanner. The digital images were then transferred to a Toshiba Satellite 2210 laptop. Three general dental practitioners compared each conventional radiograph with the three matching digital images. Images were ranked for clarity and were assessed for diagnostic quality. Data were analysed using General Estimating Equations. RESULTS: The clarity and diagnostic quality of the conventional radiographs were superior to the digital images produced by the three techniques (P < 0.001). No significant difference was found between the Nikon D1X and Camedia 2500-L cameras for clarity or diagnostic quality. The scanner was equivalent to the Camedia 2500-L camera for diagnostic quality, but was otherwise inferior to both cameras. CONCLUSIONS: Digitizing conventional radiographs using current high-grade digital cameras or scanners does not produce images of diagnostic quality. Improved resolution of viewing monitors is necessary to fully harness the potential of digital technology.

Computer Terminals↗

PubMed1999

Maternal and child health statistics: Russian Federation and United States, selected years 1985-95.

This report provides comparative maternal and child health data for recent years for the Russian Federation and the United States. Statistical data for Russia are from the Ministry of Health of Russia and from Goskomstat, the central statistical organization of Russia. Information for the United States comes from various data systems of the National Center for Health Statistics as well as other parts of the Department of Health and Human Services. A background section provides a description of each country's health care system and national guidelines for maternal and child health care. This information is intended to assist the reader in interpreting the subsequent sections on various aspects of maternal and child health. The report uses tables, figures, and commentary to present information on many different health measures for mothers, infants, children, and adolescents in the two countries. Topics covered include population size, prenatal and obstetrical care, abortions, natality, breastfeeding, mortality, immunization, communicable diseases, and other morbidity measures. The commentary includes a discussion of data quality issues that affect the accuracy and comparability of the information presented. Data are provided for selected years from 1985 to 1995. When available, additional detail is provided for key subgroups of each population: for the Russian Federation, urban and rural populations; for the United States, black and white racial groups. A glossary of terms at the end of the report provides additional information on definitions and data sources and limitations.

Abortion, Induced↗

PubMed1992

Physical restraints in the practice of medicine. Current concepts.

OBJECTIVE: This article reviews the current status of the utilization of physical restraints in the practice of medicine. Based on current data from the reference sources, appropriate guidelines for the utilization of physical restraints in the practice of medicine are presented. DATA SOURCES: A review of the current literature as referenced in the article. Only English-language references were used. STUDY DESIGN: Articles were selected based on a review of articles from Index Medicus, English-language only. Articles were reviewed by the author for validity and appropriateness. DATA EXTRACTION: The guidelines of data quality, validity, and appropriateness were applied to all articles by the author. DATA SYNTHESIS: Restraints are frequently used in the practice of medicine. As many as 85% of nursing home patients will be restrained at some time and up to 17% of hospitalized medical patients will be restrained. This treatment is not always appropriate but there are no current guidelines available for the practicing physician to assist him or her in these decisions. The current use of physical restraints is discussed. The risks of restraints are reviewed and the reasons for restraint use are cited. The question regarding the efficacy of restraints is directly addressed for each of the situations in which restraints are most commonly used. The ethical and legal considerations concerning the use of restraints are reviewed, current concepts are summarized, and guidelines for improved usage of restraints are suggested. CONCLUSIONS: Despite their extensive use, there is virtually no evidence to support the efficacy of restraints. The risks of using mechanical restraints are numerous and well documented. The detrimental psychologic impact of restraints needs to be emphasized. Restraints are inappropriately used if employed because of fear of liability should a patient fall. The proper approach to the patient at risk of falling is to address the contributing factors that place the patient at risk and, where possible, correct them. Restraints are overused in medicine. Guidelines are given to help improve the employment of this potentially harmful practice.

Accidental Falls↗

PubMed2003

Vital and health statistics: Russian Federation and United States, selected years 1985-2000 with an overview of Russian mortality in the 1990s.

This report provides comparative vital and health statistics data for recent years for the Russian Federation and the United States. Statistical data for Russia and from the Ministry of Health of Russia and from Goskomstat, the central statistical organization of Russia. Information for the United States comes from various data systems of the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) as well as other parts of the Department of Health and Human Services. The initial section of the report summarizes information on recent mortality trends in the Russian Federation. During the 1990s, Russia experienced a major increase in mortality from 1990 to 1994, a substantial reduction in mortality from 1994 to 1998, and another major increase from 1998 to 2000. The mortality overview uses tables and figures to describe mortality changes by age group, sex, and cause of death, and to determine the contribution of each of these to changes in life expectancy. The overview also considers risk factors and other issues underlying these trends, in an attempt to understand the impact of major mortality determinants on changes in life expectancy. The section on vital and health statistics uses tables, figures, and commentary to present information on many different health measures for the populations of the two countries. Topics covered include population size, fertility, life expectancy, infant mortality, death rates, communicable diseases, and various health personnel and health resource measures. The commentary includes a discussion of data quality issues that affect the accuracy and comparability of the information presented. Data are provided for selected years from 1985 to 2000. In addition to national data, mortality information on urban and rural subgroups in Russia is provided. A glossary of terms at the end of the report provides additional information on definitions and data sources and limitations.

Adolescent↗

PubMed2004

Using encounter data from Medicaid HMOs for research and monitoring.

Complete encounter data from Medicaid HMOs are necessary to monitor patient access to care, compute risk-adjusted payments, and estimate savings from managed care. Encounter data from TennCare for 1996 and 1997 appear to be incomplete. This is the case despite state review of data quality, financial sanctions for Medicaid HMOs that appeared to be submitting incomplete data, and a preliminary assessment of encounter data for samples of two Medicaid enrollee subgroups suggesting that the encounter data might be reasonably complete. Although all states are required to submit Medicaid encounter data to the government, most states currently produce incomplete encounter data.

Cost-Benefit Analysis↗

PubMed2006

The use of missing birth record data as a marker for adverse reproductive outcomes: a geocoded analysis of birth record data.

Adverse reproductive outcomes (AROs) disproportionately affect black American infants and significantly contribute to the U.S. infant mortality rate. Without accurate understanding of AROs, there remains little hope of ameliorating infant mortality rates or eliminating infant health disparities. However, despite the importance of monitoring infant mortality rates and health disparities, birth record data quality is not assured. Racial disparities in the reporting of birth record data have been documented, and missing birth record data for AROs appears to be disproportionate. Due to the extent of missing birth record data, innovative strategies have been developed to evaluate relationships between maternal socioeconomic status (SES) and community-based ARO rates. Because addresses convey aggregate information about income level, education and occupation, ZIP codes, census tracts and census block-groups have been applied to geocoding efforts. The goals of this study are to: 1) analyze the extent of missing birth record data for New Jersey areas with high rates of an ARO (preterm birth), 2) evaluate associations between the extent of missing birth record data and other AROs, and 3) consider how geocoding strategies could be applied to provide a basis for understanding maternal SES risk factors and ARO resource allocation for at-risk communities.

Adult↗

PubMed1998

Integrating clinical and laboratory data in genetic studies of complex phenotypes: a network-based data management system.

The identification of genes underlying a complex phenotype can be a massive undertaking, and may require a much larger sample size than thought previously. The integration of such large volumes of clinical and laboratory data has become a major challenge. In this paper we describe a network-based data management system designed to address this challenge. Our system offers several advantages. Since the system uses commercial software, it obviates the acquisition, installation, and debugging of privately-available software, and is fully compatible with Windows and other commercial software. The system uses relational database architecture, which offers exceptional flexibility, facilitates complex data queries, and expedites extensive data quality control. The system is particularly designed to integrate clinical and laboratory data efficiently, producing summary reports, pedigrees, and exported files containing both phenotype and genotype data in a virtually unlimited range of formats. We describe a comprehensive system that manages clinical, DNA, cell line, and genotype data, but since the system is modular, researchers can set up only those elements which they need immediately, expanding later as needed.

Clinical Laboratory Information Systems↗

PubMed2003

Benchmarking variation in coding accuracy across the United States.

The objective of this study was to measure the consistency of coded medical data through information managers' reports of the overall coding error level in patients' medical records. Using a cross-sectional design, we examined the reported percent of records containing coding errors significant enough to change a diagnostic related group (DRG). Results indicate about 87 percent, 9 percent, and 5 percent of respondents reported that significant coding errors existed in less than 5 percent, 6-10 percent, and greater than 10 percent of the medical records in their institutions, respectively. Significant variation was found in the accuracy and consistency of coding practice and associated data quality across key demographic and organizational variables. Significantly large error rates in coded data exist in some organizations. Given variations across key demographic characteristics, providers may tend to distrust all coded data, when aggregated. As the United States moves toward an evidence-based medicine environment, the use of current patient data classification methods may be of limited value without increased attention to coding practices.

Benchmarking↗

PubMed2006

Relating landscape characteristics to non-point source pollution in mine waste-located watersheds using geospatial techniques.

Landscape characteristics of a watershed are important variables that influence surface water quality. Understanding the relationship between these variables and surface water quality is critical in predicting pollution potential and developing watershed management practices to eliminate or reduce pollution risk. To understand the impacts of landscape characteristics on water quality in mine waste-located watersheds, we conducted a case study in the Tri-State Mining District which is located in the conjunction of three states (Missouri, Kansas and Oklahoma). Severe heavy metal pollution exists in that area resulting from historical mining activities. We characterized land use/land cover over the last three decades by classifying historical multi-temporal Landsat imagery. Landscape metrics such as proportion, edge density and contagion were calculated based on the classified imagery. In-stream water quality data over three decades were collected, including lead, zinc, iron, cadmium, aluminum and conductivity which were used as key water quality indicators. Statistical analyses were performed to quantify the relationship between landscape metrics and surface water quality. Results showed that landscape characteristics in mine waste-located watersheds could account for as much as 77% of the variation of water quality indicators. A single landscape metric alone, such as proportion of mine waste area, could be used to predict surface water quality; but its predicting power is limited, usually accounting for less than 60% of the variance of water quality indicators.

Animals↗

PubMedDate not supplied

Executive roundtable II. Talking about quality.

In the last issue of Healthcare Executive, we introduced the first in a two-part series on quality in healthcare. The series, which is predicated on a five-hour roundtable discussion among eight healthcare leaders, was moderated by Thomas C. Dolan, Ph.D., FACHE, CAE, ACHE's president and chief executive officer, and jointly sponsored by ACHE and the Bayer Quality Network, an educational forum for sharing innovative and effective continuous quality improvement methods with healthcare executives. In Part I, participants spoke about current issues as they relate to quality. They discussed the reliability of existing quality data and expressed a need for more practical indicators and measurement systems. The consumer mindset was discussed, as leaders debated the value of customer satisfaction surveys and ways to create more realistic consumer expectations. In terms of employers and third parties, participants suggested tailoring quality information and presenting it in a simplified fashion. Finally, leaders emphasized the need for better performance information, as well as the use of outcomes data for both educational and quality improvement purposes. In Part II, the dialogue remains compelling. Participants cover new ground as they talk about the role of accreditors in regulating quality, of governance teams and senior management in creating an organizational culture to support quality, and of physicians in attracting both business partners and patients based on quality. Following is the second in our two-part series.

Accreditation↗

PubMed2003

Identifying physician-recognized depression from administrative data: consequences for quality measurement.

BACKGROUND: Multiple factors limit identification of patients with depression from administrative data. However, administrative data drives many quality measurement systems, including the Health Plan Employer Data and Information Set (HEDIS). METHODS: We investigated two algorithms for identification of physician-recognized depression. The study sample was drawn from primary care physician member panels of a large managed care organization. All members were continuously enrolled between January 1 and December 31, 1997. Algorithm 1 required at least two criteria in any combination: (1) an outpatient diagnosis of depression or (2) a pharmacy claim for an antidepressant Algorithm 2 included the same criteria as algorithm 1, but required a diagnosis of depression for all patients. With algorithm 1, we identified the medical records of a stratified, random subset of patients with and without depression (n = 465). We also identified patients of primary care physicians with a minimum of 10 depressed members by algorithm 1 (n = 32,819) and algorithm 2 (n = 6,837). RESULTS: The sensitivity, specificity, and positive predictive values were: Algorithm 1: 95 percent, 65 percent, 49 percent; Algorithm 2: 52 percent, 88 percent, 60 percent. Compared to algorithm 1, profiles from algorithm 2 revealed higher rates of follow-up visits (43 percent, 55 percent) and appropriate antidepressant dosage acutely (82 percent, 90 percent) and chronically (83 percent, 91 percent) (p < 0.05 for all). CONCLUSIONS: Both algorithms had high false positive rates. Denominator construction (algorithm 1 versus 2) contributed significantly to variability in measured quality. Our findings raise concern about interpreting depression quality reports based upon administrative data.

Algorithms↗

PubMed2002

Quality of life and back pain: outcome 16.7 years after Harrington instrumentation.

STUDY DESIGN: A study on the quality of life of 82 patients with idiopathic scoliosis treated with Harrington instrumentation. OBJECTIVE: To analyze long-term health-related quality of life and low back pain an average of 16.7 years after surgery. SUMMARY AND BACKGROUND DATA: Quality of life evaluated by self-assessment questionnaires is an accepted outcome measure of surgical procedures. The purpose of this study was to evaluate the health status with the German version of internationally accepted and psychometrically tested questionnaires. METHODS: Quality of life was measured with the Short Form-36 health profile. Low back pain was assessed using the Roland-Morris Questionnaire. Demographic data (age, sex, follow-up time), radiographic analysis (Kings classification, Cobb angle, extension and site of fusion), and rib cage deformity were correlated with these data. Radiologic parameters were analyzed longitudinally. RESULTS: In comparison with the age-matched healthy population, there was no significant difference in the physical Short Form-36 scale (P = 0.98). Surgically treated patients showed significantly lower scores than at baseline in the psychologic Short Form-36 scale (P = 0.005); vitality (P < 0.001), general mental health (P = 0.003), and role activities because of emotional problems (P < 0.001) were significantly different from those of the age-matched population. Sixty-five (79.3%) of the 82 patients reported no or occasional back pain in the Roland-Morris Questionnaire. Five patients (6.1%) reported chronic back pain. Neither patient age at the time of surgery (P = 0.74) nor time of follow-up (P = 0.44), type of scoliosis (P = 0.56), or extent of fusion (P = 0.12) was associated with health-related quality of life or pain. The size of the preoperative (P = 0.06) and postoperative (P = 0.12) curves and preoperative (P = 0.28) and postoperative (P = 0.7) rib cage deformities did not correlate with the data of the Short Form-36 scale and the Roland-Morris Questionnaire. CONCLUSIONS: In comparison with the age-matched population, the long-term effect of surgery does not affect the physical quality of life. The psychologic health status is, however, significantly impaired. Neither the type of curve, the size of scoliosis, nor the rib cage deformity influences the data.

Adolescent↗