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PubMed2003

The alcohol interlock: an underutilized resource for predicting and controlling drunk drivers.

This report summarizes evidence presented during the Third Annual Ignition Interlock Symposium at Vero Beach, Florida, 29 October 2002. The ignition interlock prevents a car from starting when blood alcohol concentration (BAC) is elevated. We review some of our prior work as well as introduce previously unpublished results to demonstrate the manner in which the data recorded by the alcohol ignition interlock device can serve as an advance predictor of future driving under the influence (DUI) of alcohol risks. Data used in this current report represent approximately 2,200 ignition interlock users from Alberta, Canada, and about 8,000 interlock users from Quebec, Canada; the Alberta data set contained 5.5 million breath tests and the Quebec data 18.8 million breath tests. All tests are time and date stamped and this information was used to characterize patterns of BAC and vehicle use, and the relationship between BAC elevations and DUI offenses that accumulated after the interlock was removed from the vehicles. Findings from Cox regression (Marques et al., 2003) show that BAC elevations > .02-.04% are more potent predictors of repeat DUI (p < .0001) than even prior DUI (p < .006), usually found to be the strongest indicator of driver risk. Prior DUI obviously has no use for scaling the risk of first-time offenders. Drivers who are both multiple offenders and who have more than a few elevated interlock BAC tests are much more likely to repeat DUI. The timing and pattern of elevated BAC tests provided during the time drivers were required to use an alcohol ignition interlock device are remarkably similar on both a daily basis and an hourly basis when the interlock programs from the two provinces are compared directly. Both provinces had higher rates of elevated tests on Saturday and Sunday, and the fewest elevated tests on Tuesdays. The absolute rate of elevated tests is similar despite the two provinces adhering to different interlock lockout points (.02% Quebec; .04% Alberta). Charts tracking the Monday-Friday timing of elevated BAC tests by hour are nearly identical for both provinces. The most elevated BAC tests occurred between 7 and 9 A.M. Monday to Friday, even though most vehicle start attempts occurred much later in the day. This higher rate of elevated morning BAC likely represents drinking from the prior evening with alcohol not yet cleared from circulation; those with elevated BAC in the early morning were more likely to have a repeat offense even after accounting for prior DUI and the higher overall rate of elevated BAC tests. This is viewed as evidence of a drinking problem that will lead to impaired driving after the controlling function of the interlock is removed. Policy changes are discussed that might take better advantage of interlock information to improve the public response to drunk driving.

Accidents, Traffic↗

PubMed2003

The alcohol interlock: an underutilized resource for predicting and controlling drunk drivers.

This report summarizes evidence presented during the Third Annual Ignition Interlock Symposium at Vero Beach, Florida, 29 October 2002. The ignition interlock prevents a car from starting when blood alcohol concentration (BAC) is elevated. We review some of our prior work as well as introduce previously unpublished results to demonstrate the manner in which the data recorded by the alcohol ignition interlock device can serve as an advance predictor of future driving under the influence (DUI) of alcohol risks. Data used in this current report represent approximately 2,200 ignition interlock users from Alberta, Canada, and about 8,000 interlock users from Quebec, Canada; the Alberta data set contained 5.5 million breath tests and the Quebec data 18.8 million breath tests. All tests are time and date stamped and this information was used to characterize patterns of BAC and vehicle use, and the relationship between BAC elevations and DUI offenses that accumulated after the interlock was removed from the vehicles. Findings from Cox regression show that BAC elevations >.02-.04% are more potent predictors of repeat DUI (p<.0001) than even prior DUI (p<.006), usually found to be the strongest indicator of driver risk. Prior DUI obviously has no use for scaling the risk of first-time offenders. Drivers who are both multiple offenders and who have more than a few elevated interlock BAC tests are much more likely to repeat DUI. The timing and pattern of elevated BAC tests provided during the time drivers were required to use an alcohol ignition interlock device are remarkably similar on both a daily basis and an hourly basis when the interlock programs from the two provinces are compared directly. Both provinces had higher rates of elevated tests on Saturday and Sunday, and the fewest elevated tests on Tuesdays. The absolute rate of elevated tests is similar despite the two provinces adhering to different interlock lockout points (.02% Quebec;.04% Alberta). Charts tracking the Monday-Friday timing of elevated BAC tests by hour are nearly identical for both provinces. The most elevated BAC tests occurred between 7 and 9 A.M. Monday to Friday, even though most vehicle start attempts occurred much later in the day. This higher rate of elevated morning BAC likely represents drinking from the prior evening with alcohol not yet cleared from circulation; those with elevated BAC in the early morning were more likely to have a repeat offense even after accounting for prior DUI and the higher overall rate of elevated BAC tests. This is viewed as evidence of a drinking problem that will lead to impaired driving after the controlling function of the interlock is removed. Policy changes are discussed that might take better advantage of interlock information to improve the public response to drunk driving.

Accidents, Traffic↗

PubMed2003

Acquiring a four-dimensional computed tomography dataset using an external respiratory signal.

Four-dimensional (4D) methods strive to achieve highly conformal radiotherapy, particularly for lung and breast tumours, in the presence of respiratory-induced motion of tumours and normal tissues. Four-dimensional radiotherapy accounts for respiratory motion during imaging, planning and radiation delivery, and requires a 4D CT image in which the internal anatomy motion as a function of the respiratory cycle can be quantified. The aims of our research were (a) to develop a method to acquire 4D CT images from a spiral CT scan using an external respiratory signal and (b) to examine the potential utility of 4D CT imaging. A commercially available respiratory motion monitoring system provided an 'external' tracking signal of the patient's breathing. Simultaneous recording of a TTL 'X-Ray ON' signal from the CT scanner indicated the start time of CT image acquisition, thus facilitating time stamping of all subsequent images. An over-sampled spiral CT scan was acquired using a pitch of 0.5 and scanner rotation time of 1.5 s. Each image from such a scan was sorted into an image bin that corresponded with the phase of the respiratory cycle in which the image was acquired. The complete set of such image bins accumulated over a respiratory cycle constitutes a 4D CT dataset. Four-dimensional CT datasets of a mechanical oscillator phantom and a patient undergoing lung radiotherapy were acquired. Motion artefacts were significantly reduced in the images in the 4D CT dataset compared to the three-dimensional (3D) images, for which respiratory motion was not accounted. Accounting for respiratory motion using 4D CT imaging is feasible and yields images with less distortion than 3D images. 4D images also contain respiratory motion information not available in a 3D CT image.

Algorithms↗

PubMed2005

A true singles list-mode data acquisition system for a small animal PET scanner with independent crystal readout.

We present a unique data acquisition system designed to read out signals from the MADPET-II small animal LSO-APD PET tomograph. The scanner consists of 36 independent detector modules arranged in a dual-radial layer ring (phi 71 mm). Each module contains a 4 x 8 array of optically isolated, 2 x 2 mm LSO crystals, coupled one-to-one to a 32 channel APD. To take full advantage of the detector geometry, signals from each crystal are individually processed without any data reduction. This is realized using custom designed mixed-signal ASICs for analogue signal processing, and FPGAs to control the digitization of analogue signals and subsequent multiplexing. Analogue to digital converters (ADCs) digitize the signal peak height, time to digital converters (TDCs) time stamp each event relative to a system clock and two 32 bit words containing the energy, time and position information for each singles event are multiplexed through three FIFO stages before being written to disk via gigabit Ethernet. Every singles event is processed and stored in list-mode format, and coincidences are sorted post-acquisition in software. The 1152 channel data acquisition system was designed to be able to handle sustained data rates of up to 11 520 000 cps without loss (10 000 cps/channel). The timing resolution of the TDC was measured to be 1 ns FWHM. In addition to describing the data acquisition system, performance measurements made using a 128-channel detector prototype will be presented.

Animals↗

PubMedDate not supplied

Simple approach to micropattern cells on common culture substrates by tuning substrate wettability.

The ability to spatially control cell adhesion and multicellular organization is critical to many biomedical and tissue-engineering applications. This work describes a straightforward method to micropattern cells onto glass, silicone rubber, and polystyrene using commercially available reagents. An elastomeric polydimethylsiloxane stamp is used to contact-transfer extracellular matrix protein onto a surface followed by blocking cell adhesion in the surrounding regions by the physisorption of Pluronic surfactants. Using self-assembled monolayers of alkanethiols on gold as model surfaces to control surface wettability, we found that protein printing was most effective at intermediate to highly wetting surfaces whereas Pluronic adsorption occurred at intermediate to low wetting surfaces. Within a regimen of intermediate wettability both techniques were applied in conjunction to restrict cell adhesion to specified patterns. Adjusting the wettability of common tissue culture substrates to the same intermediate range again allowed the micropatterning of cells, suggesting that this approach is likely to be generally applicable to many types of materials. This technique therefore may allow for wider adoption of cell patterning.

Adsorption↗

PubMed2000

The physiologic cipher at altitude: telemedicine and real-time monitoring of climbers on Mount Everest.

Advanced wearable biosensors for vital-signs monitoring (physiologic cipher) are available to improve quality of healthcare in hospital, nursing home, and remote environments. The objective of this study was to determine reliability of vital-signs monitoring systems in extreme environments. Three climbers were monitored 24 hours while climbing through Khumbu Icefall. Data were transmitted to Everest Base Camp (elevation 17,800 feet) and retransmitted to Yale University via telemedicine. Main outcome measures (location, heart rate, skin temperature, core body temperature, and activity level) all correlated through time-stamped identification. Two of three location devices functioned 100% of the time, and one device failed after initial acquisition of location 75% of the time. Vital-signs monitors functioned from 95%-100% of the time, with the exception of one climber whose heart-rate monitor functioned 78% of the time. Due to architecture of automatic polling and data acquisition of biosensors, no climber was ever without a full set of data for more than 25 minutes. Climbers were monitored continuously in real-time from Mount Everest to Yale University for more than 45 minutes. Heart rate varied from 76 to 164 beats per minute, skin temperature varied from 5 to 10 degrees C, and core body temperature varied only 1-3 degrees C. No direct correlation was observed among heart rate, activity level, and body temperature, though numerous periods suggested intense and arduous activity. Field testing in the extreme environment of Mount Everest demonstrated an ability to track in real time both vital signs and position of climbers. However, these systems must be more reliable and robust. As technology transitions to commercial products, benefits of remote monitoring will become available for routine healthcare purposes.

Altitude Sickness↗

PubMed1976

Protein and calorie malnutrition among preschool Navajo Indian children, a follow-up.

A follow-up study was conducted on the infant and child-feeding programs to determine the prevalence of protein and calorie malnutrition among preschool Navajo Indian children. These programs were introduced on the reservation in 1968. The numbers of patients admitted to the Public Health Service Indian Hospital, in Tuba City, Arizona, with deficits in weight for their chronological ages, marasmus, and kwashiorkor were compared during two 5-year-periods, 1963 to 1967 and 1969 to 1973. The results show an 18% reduction in the total number of patients under 5 years of age admitted to the hospital and a 39% reduction in the number of patients admitted with deficits in weight for their chronological ages. Marasmus has practically disappeared, with only two cases described since the end of fiscal 1969. The number of cases of kwashiorkor has also decreased by 50%, mainly in the last 4 years. The height and weight data on 1,462 Head Start children from all over the reservation were measured in September 1973, and these measurements were compared with data obtained in September 1967. While they still show a significant deviation from the Boston growth curves, there is a definite improvement from 1967 to 1973. This improvement was especially noticeable in height. Thirty percent of the girls and 30% of the boys fell below the 3rd percentile for Boston in 1967. In 1973, these figures were 11% and 16%, respectively. In the case of the girls in 1973, the numbers below the 3rd percentile are significantly smaller for younger girls than for the older girls, suggesting that the growth retardation occurred in the first 2 years of life, and that the older children had not received the full benefit of the free infant formula feeding programs. This trend, however, was not present in boys. It is concluded that the infant and child feeding programs have contributed to improved growth among Navajo preschool children. At the same time, concern is expressed that these feeding programs will be replaced by a Food Stamp Program and that the gains made will be reversed. Concern is also expressed for the regressive effects of inflation and rising food prices and the effects they will have on the nutritional status of the Navajo people.

Arizona↗

PubMed1988

The National WIC Evaluation: evaluation of the Special Supplemental Food Program for Women, Infants, and Children. VII. Study of food expenditures.

Recalls of monthly family food expenditure, taken before and after maternal WIC benefits, were obtained from 4,219 WIC and 785 control women; 1-wk expenditure diaries (at follow-up) were obtained from 1,031 WIC and 551 control women chosen randomly. Control families had higher incomes, spent more on groceries and in restaurants, and received fewer food stamp benefits. Women probably underreported the value of WIC benefits by recall (WIC vouchers are not dollar denominated). Although control families were more affluent, there were consistent effects of children's WIC benefits on weekly family grocery expenditure by diary ($6.10, p less than 0.05) and by recall ($2.14, p less than 0.01, and $1.48, p less than 0.05). WIC benefits to infants were associated with very large (but not significant) increments in grocery spending by diary ($7.57). WIC benefits to the pregnant woman were strongly associated with larger amounts of WIC food entering the household (as were infant and child benefits) but effects on grocery spending were unclear.

Costs and Cost Analysis↗

PubMed2003

Low incidence of secondary myelodysplasia and acute myeloid leukemia after high-dose chemotherapy as adjuvant therapy for breast cancer patients: a study by the Solid Tumors Working Party of the European Group for Blood and Marrow Transplantation.

BACKGROUND: To determine the incidence of secondary myelodysplasia (sMDS) or acute myeloid leukemia (AML) in node-positive breast cancer patients who received high-dose chemotherapy (HDCT) followed by autologous stem-cell support as adjuvant therapy. PATIENTS AND METHODS: The incidence of sMDS/AML was retrospectively assessed in 364 node-positive breast cancer patients who received HDCT followed by autologous stem-cell support as adjuvant therapy between November 1989 and December 1997 and were reported to the European Group for Blood and Marrow Transplantation registry. RESULTS: The median age of the patients was 45 years (range 22-62 years). Two hundred and ninety-one patients received peripheral blood stem cells and 55 patients received autologous bone marrow as stem-cell support. The most frequently used conditioning regimen was the STAMP-V regimen (32%), followed by melphalan-thiotepa (22%) and melphalan-mitoxantrone-cyclophosphamide (21%). The 5-year probability of overall survival is 71% (95% CI 65% to 77%). After a median follow-up of 48 months (range 1-108 months) only one case of AML was observed, resulting in a crude incidence of 0.27%. This case of AML was observed 18 months after HDCT consisting of three cycles of epirubicin and cyclophosphamide with a cumulative dose of epirubicin 960 mg and cyclophosphamide 19 g. The French-American-British type of AML was M4, and the cytogenetic analysis showed a translocation t(9;11)(p22;q23). After complete remission following high-dose cytarabine and idarubicin the patient relapsed and died. CONCLUSIONS: In contrast to patients with malignant lymphoma there seems to be no increased risk of sMDS/AML after HDCT in breast cancer. Continued monitoring is required to confirm this low incidence after a longer follow-up period.

Acute Disease↗

PubMed1984

Determination of the distribution of cannabinoids in cannabis resin from the Lebanon using HPLC. Part III.

Samples taken from 61 slabs of cannabis resin originating in The Lebanon were examined by high performance liquid chromatography. The slabs were derived from seizures of cannabis resin made over a three-year period. From a study of 14 of these samples, taken from bags which bore a number of identical stamp marks, it was shown that there was a correlation between the cannabinoid distribution and the marks. The remaining 47 samples of cannabis resin, all of which were from bags with different marks, were each found to have a unique cannabinoid distribution. Such an examination can therefore be used to aid investigations where evidence of a common origin is sought.

Cannabinoids↗

PubMed2005

Environmental tobacco smoke in Norwegian homes, 1995 and 2001: changes in children's exposure and parents attitudes and health risk awareness.

BACKGROUND: The aims of the present study were to assess changes between 1995 and 2001 in the prevalence of child exposure to environmental tobacco smoke (ETS), attitudes towards ETS among parents of small children and awareness among parents regarding the potential hazards of passive smoking to children. METHOD: A questionnaire, along with a stamped, addressed envelope, was sent to a stratified random sample of 1000 households in Norway containing children aged 3 years old at the time of the investigation (May 1995 and August 2001). RESULTS: The prevalence of households containing smokers was similar in the two study periods. However, households reporting exposure of children to ETS fell from 32% in 1995 to 18% in 2001. Health-risk awareness had significantly increased in households containing smokers. In both surveys, the probability of children being exposed to ETS was positively correlated with the number of parents smoking, and inversely correlated to strength of health-risk awareness, negative attitudes towards ETS and length of household education. CONCLUSIONS: Increasing parents' awareness of the health risk of ETS exposure to children may significantly reduce children's ETS exposure.

Adult↗

PubMed2000

Patient adherence to family practitioners' recommendations for breast cancer screening: a historical cohort study.

BACKGROUND: Breast cancer is the most prevalent malignancy among women in Israel, and routine screening is recommended for early detection. In 1997, a health management organization primary care centre in rural Israel established a 1-year programme wherein family physicians were encouraged to remind their patients to undergo breast cancer examinations. This study evaluates the impact of the physicians' intervention on patient compliance. METHODS: Family practitioners from two practices were requested to discuss the importance of early breast cancer detection with all eligible patients who visited the clinic for any reason and to assist them in scheduling an appointment for screening. The files of the patients who received the recommendation were stamped accordingly. On completion of the programme, the physicians' files were audited, and the potential candidates for breast cancer screening were divided into two groups: those who had received the intervention (n = 251) and those who had not (n = 187); results were also compared with those of a third group of patients who had gone for an examination on their own initiative (n = 100) prior to the study (i.e. did not require intervention). A random sample of half the patients also completed an ad hoc questionnaire covering sociodemographic variables and the impact of the doctors' intervention on their behaviour. RESULTS: Patients in the intervention group showed a significantly greater change in behaviour regarding breast cancer screening than the controls (32% versus 13%, P = 0.001). This change was manifested particularly in the group of women aged 50-74 years who received the recommendation for mammography to be performed (according to the guidelines). CONCLUSION: Although this is a study in only two practices, the results suggest that primary care physicians can significantly alter the behaviour of their patients regarding regular breast examinations. The use of a special reminder can also help the individual doctor to ensure that each patient has been properly instructed.

Adult↗

PubMed1995

Movements out of poverty among elderly widows.

Elderly widows are disproportionately in poverty in the United States. However, past research has also shown that a significant number of poor elderly widows do move out of poverty. This work addresses two questions: What are the characteristics of elderly widows who exited from poverty, and what is the magnitude of the increase in income at the time of exit? An event history approach was taken using monthly data from the Survey of Income and Program Participation. Some of the findings are: living with family members is a strong predictor for the transition out of poverty among poor elderly women; those who are permanently impoverished tend to rely solely on food stamps and SSI; elderly widows from poverty with relatively large increases in income; those who exited due to an increase in pension income or gifts had increased their income significantly more than those who exited through other sources.

Aged↗

PubMed1975

Feedback effects on the performance and self-reinforcing behavior of elderly and young adult women.

A total of 64 college-aged and elderly women participated in an experimental study of the effects of noncontingent positive feedback on simple speeded performance, performance self-evaluations, and self-reinforcing behavior (i.e., the number of S&H Green Stamps taken following feedback). Younger women self-reinforced more and held higher self-evaluations of their performance than elderly women. The treatment produced increases in all three dependent measures, and greater increases in self-reinforcing behaviors and self-evaluations were demonstrated for the elderly than for the younger women. The results are discussed in terms of age-associated differences in the susceptibility to external feedback.

Achievement↗

PubMed1999

A tailored multimedia nutrition education pilot program for low-income women receiving food assistance.

This article describes the development and pilot evaluation of a tailored multimedia program to improve dietary behavior among 378 low-income women enrolled in the Food Stamp program in Durham, North Carolina. After randomization to intervention or control groups, participants completed a baseline survey and were resurveyed 1-3 months post-intervention. Measures included dietary fat intake assessed using a brief food-frequency questionnaire, stage of change, knowledge of low-fat foods, self-efficacy and eating behavior questions. The computer-based intervention consisted of a tailored soap opera and interactive 'info-mercials' that provided individualized feedback about dietary fat intake, knowledge and strategies for lowering fat based on stage of change. At follow-up, intervention group participants had improved significantly in knowledge (P < 0.001), stage of change (P < 0.05) and certain eating behaviors (P < 0.05) compared to the control group. Both study groups had lowered their reported fat intake markedly at follow-up (P < 0.001), but did not differ significantly from each other. A majority of participants rated the program as very helpful and were interested in using a similar program in the future. The findings of this pilot study suggest that computerized tailored self-help health promotion programs may be effective educational interventions for lower income and minority populations.

Adult↗

PubMed2000

A quasi-experimental study on a quality circle program in a Taiwanese hospital.

OBJECTIVE: To explore the impact of quality circles on job satisfaction, absenteeism, and turnover among hospital nurses in Taiwan. DESIGN: A quasi-experimental research design. SETTING: In November 1995, a study was initiated to establish quality circles in a 500-bed community hospital in Taiwan. After the administrative process and a pilot study, three of the experimental units began implementing the quality circle program in January 1997. For the comparison group, three non-quality circle medical-surgical units were selected from another building. STUDY PARTICIPANTS: All registered nurses on the three selected units who met the criteria of having worked full-time on those units for > or = 6 months were included in the study. There were 53 full-time registered nurses (49 female, four male) who met the criteria and 100% participated. There were no significant differences between the quality circle group and the non-quality circle group in terms of sex, age, and number of years of working experience, education or marital status. INTERVENTIONS: After obtaining administrative approval and support, the pilot study began with 3-month quality circle courses and 3-month quality circle process training for the experimental group nurses. Each circle has been meeting for 1 hour each week to identify problems, barriers, and solutions for effective implementation since 1997. MAIN OUTCOME MEASURES: (i) Demographic data questionnaire; (ii) Stamps and Piedmont's Index of Work Satisfaction; (iii) hospital records for absenteeism and turnover data. RESULTS: The data reveal that nurses of the three quality circle units felt more satisfied (P < 0.01) than did nurses from the three non-participating units. In the non-participating group, 36% had considered leaving the units, compared to 10% of nurses from the quality circle group. The turnover rate was significantly higher for the non-participating group (40%) than for the quality circle group (13%). CONCLUSION: This quality circle program in a Taiwanese hospital significantly improved satisfaction, reduced absenteeism, and lowered turnover of nurses. The findings support other studies reported in the literature.

Absenteeism↗

PubMed2005

Results of a national asthma campaign survey of primary care in Scotland.

OBJECTIVE: To identify within primary care in Scotland how far procedures for asthma review and patient education match guideline recommendations. DESIGN AND SETTING: Telephone survey of a one in four stratified random sample of all 1058 general practices in Scotland. PARTICIPANTS: Practice nurses, general practitioners. MAIN OUTCOME MEASURES: Number of practices matching guideline recommendations for asthma review, targeting of care, use of structured asthma records, provision of management plans, education, and regular audit. RESULTS: Of 276 general practices contacted 91% (251) completed the questionnaire; 93% (228) ran an asthma review service; 74% (166) employed a specially trained asthma nurse; 39% (106) had a policy for providing action plans; 63% (155) had carried out an asthma audit in the previous 3 years; 76% (218) used a structured tool in consultations, 46% with use of computer technology, 34% used only a manual stamp. Sixty-six per cent (173) had searched for patients overusing beta2 agonists; 32% (79) had searched for patients on medication treatment step 3 and above. Single- or two-partner practices were less likely to follow guideline recommendations but neither rurality nor deprivation was related to guideline compliance. CONCLUSIONS: Three-quarters of Scottish general practices have trained asthma nurses and offer patients asthma review, but only a minority have proactive care procedures for targeting patients or a policy for providing patients with action plans. Practice systems are underused for identifying 'at-risk' patients. There is a need for proactive procedures and provision of self-management materials to patients. Access to trained asthma nurses needs to be improved.

Asthma↗

PubMed1989

Job satisfaction among music therapists.

Job satisfaction surveys were mailed to 2,371 registered and certified members from the National Association for Music Therapy (NAMT) and the American Association for Music Therapy (AAMT). Materials included a 36-item questionnaire and a stamped, return addressed envelope. Of the questionnaires distributed, 1,344 (57%) were returned. Reliability analysis of the job satisfaction scale, performed as a measure of internal consistency on 885 cases, revealed an alpha coefficient of .85. The measure of job satisfaction used in this study is therefore accepted as highly reliable. The present study suggests that music therapists indeed report a pleasurable emotional state as they evaluate their jobs. The nature of music therapists' work and other conditions of their employment contribute to high job satisfaction.

Analysis of Variance↗