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PubMed2003

STRING: finding tandem repeats in DNA sequences.

MOTIVATION AND RESULTS: The importance of Tandem Repeats in some genomes is now well established. We have reported elsewhere some interesting new results obtained by means of a preliminary program for finding Tandem Repeats in DNA sequences, together with a brief description of the basic ideas of the algorithm. We describe here a completely new program based only in part on those ideas, we briefly discuss the interpretation of the results, and, by way of example, we provide a few novel results relative to the parasites responsible of two re-emerging diseases, Plasmodium falciparum and Mycobacterium tuberculosis. Our program is portable, effective, powerful and fast: it can run on current desktop computers, and it finds all significant Tandem Repeats also in the longest segments of sequences in databases (up to millions of bases), in short times (minutes). AVAILABILITY: An academic version of the algorithm (full source listing in standard C language) can be freely downloaded (http://www.caspur.it/~castri/STRING/). SUPPLEMENTARY INFORMATION: Some illustrative figures and some sample results are provided as supplementary material at: http://www.caspur.it/~castri/STRING/

Algorithms↗
PubMed1990

Randomization, statistics, and causal inference.

This paper reviews the role of statistics in causal inference. Special attention is given to the need for randomization to justify causal inferences from conventional statistics, and the need for random sampling to justify descriptive inferences. In most epidemiologic studies, randomization and random sampling play little or no role in the assembly of study cohorts. I therefore conclude that probabilistic interpretations of conventional statistics are rarely justified, and that such interpretations may encourage misinterpretation of nonrandomized studies. Possible remedies for this problem include deemphasizing inferential statistics in favor of data descriptors, and adopting statistical techniques based on more realistic probability models than those in common use.

Bayes Theorem↗
PubMed1982

Apraxia and the neurophysiology of motor control.

Liepmann's description of apraxia still serves as a point of reference for neurological thinking about higher motor function. The extent to which this model is accessible to interpretation in the light of current neurophysiological knowledge has been examined. Planning and programming processes have been distinguished, and the separate roles of striopallidal and cerebellar loops in the generation of those processes have been considered in relation to the contribution of parietal and frontal association areas. It is emphasized that a new taxonomy of action is imperative in order that neurophysiological and psychological approaches can be correlated in the study of higher motor function and its pathological disorders.

Animals↗
PubMed2002

Conjoined twins in the 16th century.

The major morphological types of conjoined twins had all been described by 1600, often in publications that included details of the time and place of birth, morphology, outcome, behaviour, and, on occasion, autopsy findings. These descriptions differ from modern reports in emphasizing the twins' supposed "meaning" rather than their cause. Understanding the symbolic aspects of these accounts is important for their interpretation. This article summarizes the records of 53 cases of conjoined twins born in 16th-century Europe and examines the cultural background of these accounts and the use of the pediatric autopsy as a means of investigating the pathology of twins. Studies of conjoined twins were central to the debate over whether the possession of separate hearts was a prerequisite for individuality.

Europe↗
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↗
PubMed1980

Model analysis of transcapillary exchange: the role of cyclotron produced isotopes in the study of the capillary permeability of substances.

The purpose of this paper is to review different models used in the interpretation of capillary permeability studies using tracer dilution methods, with special emphasis on the role of cyclotron-produced isotopes. The physical model is a simplified description of the biological system, and the mathematical formalism is a device by which the model and experimental data can be compared. If there is a correlation and the solution is unique and consistent, the model is considered acceptable. Capillaries--the end organs of the circulatory system--are physiologically important because they are the site for the exchange of materials (oxygen, glucose, waste products etc.). The positive and negative findings in radionuclide imaging studies are caused by changes in capillary permeability. The indicator diffusion methods have many advantages over the conventional compartmental analyses. The diffusion models take into account the normal histological structure of the tissue and it is possible to get information about both capillary and cellular physiology. Short-lived, cyclotron produced positron emitting radionuclides, carbon-11, nitrogen-13, oxygen-15 and fluorine-18, are suitable for the study of transcapillary exchange.

Capillary Permeability↗
PubMed1980

[Radiological anatomy appearances of the colon after double contrast examination (author's transl)].

In this article, concerned with the normal radiological anatomy appearances of the colon after double contrast (mucography) examination, the authors develop the notion of an anteroposterior spatial disposition of the colon. Knowledge of the inclined zones, variable with incidence, in which the barium accumulates, is derived from this notion which appears, therefore, to be of practical value when performing or interpreting double contrast images. The second part of the article concerns a radiological study of the haustrations (blind sacs) and valves of the colon. This precise description of the three rows of haustral sacs could have topographical value in pathological conditions.

Barium Sulfate↗
PubMed1999

Structure and performance of different DRG classification systems for neonatal medicine.

There are a number of Diagnosis-Related Group (DRG) classification systems that have evolved over the past 2 decades, each with their own strengths and weaknesses. DRG systems are used for case-mix trending, utilization management and quality improvement, comparative reporting, prospective payment, and price negotiations. For any of these applications it is essential to know the accuracy with which the DRG system classifies patients, specifically for predicting resource use and also mortality. The objective of this study was to assess the adequacy of the three most commonly used DRG systems for neonatal patients-Medicare DRGs, All Patient Diagnosis-Related Groups (AP-DRGs), and All Patient Refined Diagnosis-Related Groups (APR-DRGs). A 2-part methodology is used to assess adequacy. The first part is a descriptive analysis that examines the structural characteristics of each system. This provides a framework for understanding the inherent strengths and weaknesses of each system and for interpreting their statistical performance. The second part examines the statistical performance of each system on a large nationally representative hospital database. The analysis identifies major differences in the structure and statistical performance of the three DRG systems for neonates. The Medicare DRGs are structurally the least developed and yield the poorest overall statistical performance (cost R2 = 0.292; mortality R2 = 0.083). The APR-DRGs are structurally the most developed and yield the best statistical performance (cost R2 = 0.627; mortality R2 = 0.416). The AP-DRGs are intermediate to Medicare DRGs and APR-DRGs, although closer to APR-DRGs (cost R2 = 0.507; mortality R2 = 0.304). An analysis of payment impacts and systematic effects identifies there are major systematic biases with the Medicare DRGs. At the patient level, there is substantial underpayment for surgical neonates, transferred-in neonates, neonates discharged to home health services, and neonates who die. In contrast, there is substantial overpayment for normal newborns. At the facility level, there is substantial underpayment for freestanding acute children's hospitals and major teaching general hospitals. There is overpayment for other urban general hospitals but this pattern varies by hospital size. There is very substantial overpayment for other rural hospitals. The AP-DRGs remove the majority of the systematic effects but significant biases remain. The APR-DRGs remove most of the systematic effects but some biases remain.

Diagnosis-Related Groups↗
PubMedDate not supplied

CAN'T MISS--conquer any number task by making important statistics simple. Part 2. Probability, populations, samples, and normal distributions.

Healthcare quality improvement professionals need to understand and use inferential statistics to interpret sample data from their organizations. In quality improvement and healthcare research studies all the data from a population often are not available, so investigators take samples and make inferences about the population by using inferential statistics. This three-part series will give readers an understanding of the concepts of inferential statistics as well as the specific tools for calculating confidence intervals for samples of data. This article, Part 2, describes probability, populations, and samples. The uses of descriptive and inferential statistics are outlined. The article also discusses the properties and probability of normal distributions, including the standard normal distribution.

Data Interpretation, Statistical↗
PubMed1995

Interpretation of EXAFS Data.

An outline of the theory of X-ray absorption as applied to X-ray absorption spectroscopy is given, concentrating on EXAFS, showing how structural parameters are contained within the theory. A full description of the scattering problem and of inelastic effects is also included, and a description is given of how structural information may be extracted from experimental data. The emphasis is on curve-fitting methods, including those techniques which allow the inclusion of external constraints.

Journal Article↗
PubMed1991

[Mediastino-abdominal lipomatosis. Description of a case].

The authors describe a case of mediastino-abdominal lipomatosis. The patient, who is 70 years old, was kept under observation, because of her recent state of illness. This state of illness was initially interpreted as angor attacks and a left ventricular failure. Only after the results of a CT examination showing a characteristic disproportion between the endothoracic-endoabdominal adipose tissue and the subcutaneous tissue, a correct interpretation was given. As a result the patient's state of illness was attributed to a compression of the adipose tissue growth in the abdominal and thoracic cavity. The etiology of mediastino-abdominal lipomatosis is still unknown. Therapy consists in removing the lipomas surgically when they cause a compression of the trachea and the upper vena cava.

Abdominal Neoplasms↗
PubMed2001

Automated examination notification of emergency department images in a picture archiving and communication system.

This study compares the timeliness of radiology interpretation of Emergency Department (ED) imaging examinations in a picture archiving and communication system (PACS) before and after implementation of an automated paging system for notification of image availability. An alphanumeric pager for each radiology subspecialty (chest, pediatrics, bone, neuroradiology, and body) was used to alert the responsible radiologist that an ED imaging examination is available to be viewed on the PACS. The paging system was programmed to trigger off of the PACS database when an image is received on the appropriate radiology display station. The pager message includes the radiology accession number and examination description (such as chest, two-view, or c-spine, etc). The PACS paging tool performance was assessed by calculating the time elapsed, for each ED imaging examination, from the Time Imaged to the Time of Interpretation, where the Time Imaged is the actual image completion time measured at the imaging modality, and the Time Interpreted is the time a radiology interpretation is rendered to the ED, and is measured from the Radiology-to-ED fax time stamp. These measures were analyzed pre- and post-paging system implementation to determine any impact of the automated notification tool on radiology service turnaround time. Results show an improved radiology response time from image completion to interpretation rendered to ED clinicians, down from hour(s) to minutes, with the automated paging examination notification system. Examinations are read by the appropriate radiology specialty section in a more timely fashion, and fewer cases go unread by radiology.

Emergency Service, Hospital↗
PubMed1986

Data collection, analysis, and interpretation in ambulatory care research: uses of the epidemiologic method.

In summary, in the collection, analysis, and interpretation of study data, individuals planning and analyzing the results of their own investigations or those of others must be particularly careful about the potential pitfalls that may occur. Considerable time and effort beforehand should be given to the type of study design (observational versus randomized trial) to be utilized; the scope of the investigation to be carried out, be it of a small descriptive scale or a large collaborative effort; attention to detail in the development of the data-collection instruments; and extensive training and continued monitoring of the data abstractors. Awareness of these factors should enhance data collection efforts, the quality of the collected data, and any interpretation thereof.

Ambulatory Care↗
PubMed2002

Evaluation of published clinical studies for reproducibility, comparability and adherence to evidence-based methods.

PURPOSE: To evaluate the "Materials and Methods" of long-term clinical studies in relation to documentation, reproducibility and comparability with and without employing the systematic methods of evidence-based medicine. MATERIALS AND METHODS: The "Materials and Methods" sections in 45 clinical long-term published studies of direct posterior resin-based composite restorations were evaluated for their use of systematic methods of evidence-based medicine. The search was limited to the years 1988-1997, using the key words "clinical study/evaluation/results/report, long-term, in vivo, posterior, Class I/II, composite, restoration". Special attention was directed to comparisons of the underlying documentation, descriptions of the operative techniques used, and their reproducibility. In addition, an evidence-based search was carried out using the Internet PubMed interface for MEDLINE, using identical synonyms, to identify studies with high levels of quality of evidence. Documentation, reproducibility, and comparability of "Materials and Methods" were also evaluated. RESULTS: Results revealed how difficult it is to interpret results based on tenuous premises, subjective standards, and inadequate study designs. Only one article could be identified when the search was limited to "humans" and "randomized clinical trials". None of the articles, even when fulfilling the highest quality of evidence, showed sufficient or satisfactory quality of reproducibility in their descriptions in Materials and Methods.

Clinical Trials as Topic↗
PubMed2003

Bangladeshi patients present with non-classic features of acute myocardial infarction and are treated less aggressively in east London, UK.

OBJECTIVE: To analyse differences in the presentation and management of Bangladeshi and white patients with Q wave acute myocardial infarction (AMI). DESIGN: Prospective observational study. SETTING: East London teaching hospital. PARTICIPANTS: 263 white and 108 Bangladeshi patients admitted with Q wave AMI. MAIN OUTCOME MEASURE: Character of presenting symptoms, their interpretation by the patient, and the provision of emergency treatment. RESULTS: There were no significant differences between Bangladeshi and white patients in the time from pain onset to hospital arrival (arrival time 64.5 (117.5) minutes v 63.0 (140.3) minutes, p = 0.63), but once in hospital it took almost twice as long for Bangladeshi as for white patients to receive thrombolysis (median (interquartile range) door to needle time 42.5 (78.0) minutes v 26.0 (47.7) minutes, p = 0.012). Bangladeshis were significantly less likely than whites to complain of central chest pain (odds ratio (OR) 0.11, 95% confidence interval (CI) 0.03 to 0.38; p = 0.0006) or to offer classic descriptions of the character of the pain (OR 0.25, 95% CI 0.09 to 0.74; p = 0.0118). These differences persisted after adjustment for age, sex, and risk factor profile differences including diabetes. Proportions of Bangladeshi and whites interpreting their symptoms as "heart attack" were similar (45.2% v 46.9%; p = 0.99). CONCLUSIONS: Bangladeshi patients with AMI often present with atypical symptoms, which may lead to slower triage in the casualty department and delay in essential treatment. This needs recognition by emergency staff if mortality rates in this high risk group are to be reduced.

Age Distribution↗
PubMed2001

A qualitative study of nursing staff members' interpretations of signs of gerotranscendence.

AIMS: This study was conducted in Sweden and investigated whether nursing staff working with old people could recognize signs of gerotranscendence and, if so, how they interpreted such signs. Another aim was to describe how the staff addressed and cared for older people, 65 and older, showing signs of gerotranscendence. BACKGROUND: The theory of gerotranscendence is a theory that, present a new understanding of the ageing process. Gerotranscendence is regarded as a natural developmental process, and the term transcendence implies a shift in an older person's meta-perspective and a new outlook on reality. METHODS: Proceeding from Tornstam's description of signs of gerotranscendence, an interview guide was designed, qualitative interviews performed and the theory of gerotranscendence was used as the basis for the qualitative analysis. FINDINGS: Findings showed that staff working with old people noticed signs of gerotranscendence. However, their interpretations were highly variable; in some cases such signs were interpreted as what might be interpreted as "pathological". This is probably because the staff had no theoretical tools with which to make other interpretations. Some signs were interpreted as common and in some cases as "normal". These could be theoretically understood from either an activity or developmental perspective. CONCLUSIONS: Staffs' need an interpretative framework allowing them to understand the signs they sometimes observe in older people. Having an interpretative framework in which these signs are seen as normal aspects of ageing would enable staff to develop a different attitude towards older people and another approach to caring for them.

Adult↗
PubMed1999

International standards for the assessment of the risk of thermal strain on clothed workers in hot environments.

The International Standards Organisation (ISO) has produced an integrated series of international standards for the assessment of human responses to thermal environments. They include standards for the assessment of thermal comfort, heat stress and cold stress and many have been adopted as European and British standards. This paper describes the series of standards and in particular those concerned with the assessment of risk in hot environments. A three tier approach is taken which involves a simple thermal index that can be used for monitoring and control of hot environments (ISO 7243), a rational approach which involves an analysis of the heat exchange between a worker and his or her environment (ISO 7933) and a standard that describes the principles of physiological measurement which can be used in the establishment of personal monitoring systems of workers exposed to hot environments (ISO 9886). The standards are self-contained and can be used independently. In any comprehensive assessment however they would be used in conjunction. The simple index provides a first stage analysis and can confirm whether or not there is likely to be unacceptable thermal strain. Where a more detailed analysis is required then ISO 7933 provides an analytical method that can provide a more extensive assessment and interpretation leading to recommendations for improvement to the working environment. Where a method needs to be confirmed, or conditions are beyond the scope of ISO 7243 and ISO 7933, then ISO 9886 provides guidance on physiological measurement and interpretation. This would be used in extreme environments where individual responses are required to ensure health and safety or, in the case where personal protective equipment (PPE) is worn, which is beyond the scope of ISO 7243 and ISO 7933. The ISO system therefore covers almost all exposures to hot environments. It would be useful however to extend the scope of the standards that provide a simple index or analytical approach. This paper describes the current standards and their scope and forms the basis and background for descriptions of proposed extensions to the scope of the standards described in other papers in this special issue.

Acclimatization↗