Estimating costs of programme services and products using information provided in standard financial statements

OBJECTIVE: To determine whether spectral analysis of unprocessed radiofrequency (RF) signal offers advantages over standard videodensitometric analysis in identifying the morphology of coronary atherosclerotic plaques. METHODS: 97 regions of interest (ROI) were imaged at 30 MHz from postmortem, pressure perfused (80 mm Hg) coronary arteries in saline baths. RF data were digitised at 250 MHz. Two different sizes of ROI were identified from scan converted images, and relative amplitudes of different frequency components were analysed from raw data. Normalised spectra was used to calculate spectral slope (dB/MHz), y-axis intercept (dB), mean power (dB), and maximum power (dB) over a given bandwidth (17-42 MHz). RF images were constructed and compared with comparative histology derived from microscopy and radiological techniques in three dimensions. RESULTS: Mean power was similar from dense fibrotic tissue and heavy calcium, but spectral slope was steeper in heavy calcium (-0.45 (0.1)) than in dense fibrotic tissue (-0.31 (0.1)), and maximum power was higher for heavy calcium (-7.7 (2.0)) than for dense fibrotic tissue (-10.2 (3.9)). Maximum power was significantly higher in heavy calcium (-7.7 (2.0) dB) and dense fibrotic tissue (-10.2 (3.9) dB) than in microcalcification (-13.9 (3.8) dB). Y-axis intercept was higher in microcalcification (-5.8 (1.1) dB) than in moderately fibrotic tissue (-11.9 (2.0) dB). Moderate and dense fibrotic tissue were discriminated with mean power: moderate -20.2 (1.1) dB, dense -14.7 (3.7) dB; and y-axis intercept: moderate -11.9 (2.0) dB, dense -5.5 (5.4) dB. Different densities of fibrosis, loose, moderate, and dense, were discriminated with both y-axis intercept, spectral slope, and mean power. Lipid could be differentiated from other types of plaque tissue on the basis of spectral slope, lipid -0.17 (0.08). Also y-axis intercept from lipid (-17.6 (3.9)) differed significantly from moderately fibrotic tissue, dense fibrotic tissue, microcalcification, and heavy calcium. No significant differences in any of the measured parameters were seen between the results obtained from small and large ROIs. CONCLUSION: Frequency based spectral analysis of unprocessed ultrasound signal may lead to accurate identification of atherosclerotic plaque morphology.     

Health status of and access to health services by residents of urban encampments in Los Angeles

This paper reports findings from a survey of 134 homeless people living in 42 urban encampments in central Los Angeles. These data, of concern to public health officials, include the physical conditions in the camps, the health status of residents, their use of drugs and alcohol, and their access to and use of health care services such as substance abuse treatment. Many encampment residents report poor health status; over 30 percent report chronic illnesses, and 40 percent report a substance abuse problem. Although outreach efforts have had success in bringing HIV and tuberculosis screening services to encampments, residents report significant barriers to using primary health care and drug and alcohol treatment services. Public hospitals and clinics remain the major source of primary medical care for homeless people living in encampments. Outreach and case management continue to be critical components of improved access to health care for homeless people.     

Organizational correlates of access to primary care and mental health services in drug abuse treatment units

The mechanism by which cells in the ampullae of the rat oviducts undergo rapid deciliation during each estrous cycle and the effects of estrogen on the ciliated cells were examined. Untreated rats were killed on each day of the 5-day estrous cycle, and the ampullae of their oviducts were removed. Other rats were injected subcutaneously each day for 5 days with 0.3 microgram or 3.0 micrograms of estradiol benzoate or with 0.3 mg of tamoxifen, an estrogen antagonist, per kilogram of body weight. The ampullae of the oviducts of the treated rats were excised on the day following the last injection. The tissues from all the rats were fixed in glutaraldehyde, stained with uranyl acetate and lead citrate, and examined with a transmission electron microscope. Deciliation of cells was seen to occur by membrane-bound cilia packets (CPs) forming at the apices of cells and pinching off. Although CPs were more numerous at proestrus, they were also observed at estrus, diestrus-1, and diestrus-2, suggesting that the process of deciliation is an ongoing one that merely changes in rate. No evidence of resorption of cilia was seen. Estradiol treatment did not prevent CPs from forming, nor was tamoxifen treatment associated with any apparent enhancement of deciliation. Ciliated cells with CPs stained more darkly than ciliated cells that were without CPs, and the former appeared similar in their staining characteristics to secretory cells, most of which stain darkly. It was concluded that the cells of the ampulla deciliate rapidly by shedding their cilia into the lumen of the oviduct, that estrogen does not halt the process, and that ciliated cells may be transformed to secretory cells following loss of their cilia.     

Resistance of falciparum malaria to chloroquine and sulfadoxine-pyrimethamine in Afghan refugee settlements in western Pakistan: surveys by the general health services using a simplified in vivo test

Surveys of drug resistant falciparum malaria were conducted in several Afghan refugee settlements, distributed over a 700 km range in western Pakistan, during the transmission seasons of 1994 and 1995. Symptomatic malaria patients were recruited by a process of passive case detection at the refugees' basic health units. To facilitate follow-up by local health workers, a modified version of the WHO extended in vivo test was adopted in which blood smears were taken from each subject, and clinical symptoms recorded, at weekly intervals. Resistance to chloroquine and sulfadoxine-pyrimethamine was identified in every settlement. The frequency of chloroquine resistance ranged from 18% to 62%. Resistance occurred mostly as RI, with RII resistance never exceeding 11%. Resistance to sulfadoxine-pyrimethamine occurred at much lower frequencies, ranging from 4% to 25%. There was a resumption of clinical symptoms at the onset of parasite recrudescence in over 90% of cases. The policy of using chloroquine as first-line treatment might be changed in favour of sulfadoxine-pyrimethamine in most camps and areas of western Pakistan. The modified in vivo test was almost as accurate as the normal WHO in vivo test in identifying the grade of resistance, and should prove a useful tool for the monitoring of resistance to common antimalarials by district health services.     

An industrial process view of information delivery to support clinical decision making: implications for systems design and process measures

Clinical decision making is driven by information in the form of patient data and clinical knowledge. Currently prevalent systems used to store and retrieve this information have high failure rates, which can be traced to well-established system constraints. The authors use an industrial process model of clinical decision making to expose the role of these constraints in increasing variability in the delivery of relevant clinical knowledge and patient data to decision-making clinicians. When combined with nonmodifiable human cognitive and memory constraints, this variability in information delivery is largely responsible for the high variability of decision outcomes. The model also highlights the supply characteristics of information, a view that supports the application of industrial inventory management concepts to clinical decision support. Finally, the clinical decision support literature is examined from a process-improvement perspective with a focus on decision process components related to information retrieval. Considerable knowledge gaps exist related to clinical decision support process measurement and improvement.     

Bacteriological and clinical assessment of tetracycline as root conditioning in adjunct to periodontal surgery

The present study was conducted on 14 quadrants from seven solicited patients. After initial phase of plaque control, six different clinical parameters were recorded and scaling and root planning performed. In each of the seven patients two Modified Widman flaps were done. One served as a control and the other as experimental in which irrigation by Tetracycline-Hcl solution 100 mg/ml for 5 minutes was performed. On comparing the two treatment modalities the tetracycline-Hcl root conditioning showed a better improvement in all the clinical parameters tested. Tetracycline irrigation gave less bacterial counts than the control group right after irrigation, however after two weeks the bacterial counts increased again and were insignificantly different in the two groups.     

Profiles of effects of traditional oriental herbal medicines on central nervous systems in humans--assessment of saiboku-to and saiko-ka-ryukotsu-borei-to using EEG and pharmacokinetics of herbal medicine-derived ingredients as indices

To elucidate usefulness of traditional oriental herbal medicines in psychiatric fields, we investigated their influences on central nervous systems in humans by using EEG and pharmacokinetics of herbal medicine-derived ingredients as the indices. The subjects were 12 healthy male volunteers who received single oral administration and after that received repeated oral administrations at a daily dose of Saiko-ka-ryukotsu-borei-to or Saiboku-to; EEG was recorded before administration, 1, 3, 6 hours and 10 days after administration. On direct comparison of global field powers calculated from 19-lead EEG before and after administration, it was verified that Saiboku-to possessed effects on central nervous systems. For assessment of pharmacokinetics of ingredients derived from Saiboku-to, pre- and post-treatment serum samples were assayed by HPLC and two ingredients were detected, besides individual differences being observed in their pharmacokinetic profiles. Given that these pharmacokinetics could be interpreted as the phenomena associated with Sho (traditional physical status classifications of patients), the subjects were classified into groups according to individual differences whereby quantitative pharmaco-EEG were employed to elucidate neurotropic effects of Saiboku-to. As the result, following two groups were evidenced: (1) a group demonstrating the mood elevator type after a single administration despite of no changes after repeated administrations, and (2) a group with a shift from the mood elevator type to the nootropics type being observed over time, delineating overt differences in EEG profiles among groups. Consequently, individual differences were evidenced to be involved in onset of neurotropic effects of Saiboku-to, permitting prediction of possible responses following repeated administrations by using EEG profiles. It was also suggested that neurotropic effects of respective ingredients could be anticipated by monitoring the time-course changes of both EEG and plasma levels of these ingredients. In summary, once further studies on oriental herbal medicines might progress based on efficacy assessments of respective ingredients with a clue of the present study, it is conceivable that these findings would play an important role as the objective indices in clinical application of herbal medicines in psychiatric fields, resulting in broadening the usefulness of oriental herbal medicines.     

Accuracy of methods using somatic cell count and N-acetyl-beta-D-glucosaminidase activity in milk to assess the bacteriological cure of bovine clinical mastitis

This study examined the capability of milk somatic cell count (SCC) and NAGase activity to discriminate between quarters that had been cured versus those that had not been cured at 4 wk after antimicrobial therapy for clinical mastitis. The distribution of microorganisms that were isolated before therapy from 630 quarters with mastitis was as follows: 225 strains of Staphylococcus aureus, 96 strains of coagulase-negative staphylococci, 152 strains of streptococci (Streptococcus dysgalactiae and Streptococcus uberis), and 157 strains of coliform bacteria. Bacteriological cure rates were 35% for mastitis caused by Staph. aureus, 75% for mastitis caused by coagulase-negative staphylococci, 66% for mastitis caused by streptococci, and 72% for mastitis caused by coliforms. Diagnostic accuracy of milk SCC and NAGase and their interquarter ratios for predicting bacteriological status of the control samples was assessed by calculating sensitivity, specificity, and accuracy and by means of receiver operating characteristic analysis. The efficiency of milk SCC and NAGase for predicting bacteriological cure was greatest for cows that had been infected with Staph. aureus. The main problem in detecting coagulase-negative staphylococci was low sensitivity, and the main problem in detecting streptococci and coliforms was low specificity. Receiver operating characteristic analysis is not completely suitable for the detection of mastitis because reference method bacteriology and indirect tests can never fully agree. To assess the recovery of cows from mastitis caused by Staph. aureus, bacteriology should be supplemented with an examination of milk SCC or NAGase activity at threshold values such as those presented here.     

Anxiety as an affective focus in the clinical study of acute behavioral distress: A reply to Shacham and Daut.

S. Shacham and R. Daut (see PA, Vol 66:00000) correctly point out that the present authors' observational scale measures pain as well as anxiety. It is noted that the focus of the authors' investigative study was on the continuous affective domain of procedural anxiety rather than on the specific response to noxious stimulation. The authors conclude that their scale would most appropriately be considered a measure of behavioral distress, incorporating components of anxiety, fear, and pain. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increase of heart rate and determination of W170 as a measure of physical working capacity in children 5 to 14 years of age (author's transl)

1. Exercise testing with stepwise increasing workload was performed in 257 healthy children (134 boys, 123 girls) on a bicycle ergometer, which was independent of variations in pedal speed within a certain range. The procedure of exercise was adapted to the children as far as possible. 2. Nomograms and standard values for heart rate during exercise and for physical working capacity at a heart rate of 170/min (W170) were established. The increase of heart rate (from 1.0 to 2.5 Watt/kg) was well correlated to the age, length, body weight and body surface. If heart rate, respectively W170 are related to workload per kg body weight, results are dependent on sex, but not on age. 3. By means of the new standard values a rough evaluation of cardiorespiratory condition is possible, if the heart rate is measured at moderate exercise during steady state. A more precise assessment of the cardio-respiratory fitness is granted by the W170. By this method physical working capacity can be determined in children with heart diseases in a relative simple manner. 4. Normally in stepwise increasing loads the exercise takes 6 minutes per workload. If this time is reduced, an underestimation of the expected heart rate, respectively an overestimation of W170 is observed, which depends on the extent of the shortening of exercise.     

Immunohistochemical evaluation of thymidylate synthase in gastric carcinoma using a new polyclonal antibody: the clinical role of thymidylate synthase as a prognostic indicator and its therapeutic usefulness

BACKGROUND: Before this study was conducted, the clinical and therapeutic significance of immunohistochemical evaluation of thymidylate synthase (TS) in patients with gastric carcinoma had not yet been clarified. METHODS: TS was immunohistochemically evaluated in 134 gastric carcinomas using anti-TS antibody. TS expression, 11 clinicopathologic variables, and survival were studied, and the correlations among them were investigated. RESULTS: The groups with high and low TS levels consisted of 56 and 78 patients, respectively. Granular cytoplasmic staining patterns of tumor cells were produced by immunohistochemical staining of the gastric carcinoma tissues. The grade of TS staining was significantly correlated with three clinicopathologic variables: depth of invasion, peritoneal metastasis, and stage of the carcinoma (P < 0.05). A univariate analysis revealed that the 5-year survival was significantly better for the low TS group than for the high TS group (P < 0.05): 65.2% for the low TS group and 43.2% for the high TS group. The group with high grade TS staining who received chemotherapy because of the advanced stage of their disease had worse prognoses even if they received adjuvant chemotherapy. A multivariate analysis revealed that four variables (peritoneal metastasis, lymphatic invasion, liver metastasis, and TS staining grade) independently contributed to survival (P < 0.05). The hazard ratio for the group with low grade TS staining was 0.464 compared with the group with high grade staining. CONCLUSIONS: The immunohistochemical evaluation of TS using this anti-TS antibody may be clinically and therapeutically useful in determining the prognosis of gastric carcinoma patients.