The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community

BACKGROUND: Despite recommendations for annual vaccination against influenza, more than half of elderly Americans do not receive this vaccine. In a serial cohort study, we assessed the efficacy and cost effectiveness of influenza vaccine administered to older persons living in the community. METHODS: Using administrative data bases, we studied men and women over 64 years of age who were enrolled in a large health maintenance organization in the Minneapolis-St. Paul area. We examined the rate of vaccination and the occurrence of influenza and its complications in each of three seasons: 1990-1991, 1991-1992, and 1992-1993. Outcomes were adjusted for age, sex, diagnoses indicating a high risk, use of medications, and previous use of health care services. RESULTS: Each cohort included more than 25,000 persons 65 years of age or older. Immunization rates ranged from 45 percent to 58 percent. Although the vaccine recipients had more coexisting illnesses at base line than those who did not receive the vaccine, during each influenza season vaccination was associated with a reduction in the rate of hospitalization for pneumonia and influenza (by 48 to 57 percent, P < or = 0.002) and for all acute and chronic respiratory conditions (by 27 to 39 percent, P < or = 0.01). Vaccination was also associated with a 37 percent reduction (P = 0.04) in the rate of hospitalization for congestive heart failure during the 1991-1992 season, when influenza A was epidemic. The costs of hospitalization for all types of illness studied were lower in the vaccinated group during 1991-1992 (range of reduction, 47 to 66 percent; P < 0.005) and for acute and chronic respiratory conditions and congestive heart failure in 1990-1991 (reductions of 37 percent and 43 percent, respectively; P < or = 0.05). Direct savings per year averaged $117 per person vaccinated (range, $21 to $235), with cumulative savings of nearly $5 million. Vaccination was also associated with reductions of 39 to 54 percent in mortality from all causes during the three influenza seasons (P < 0.001). CONCLUSIONS: For elderly citizens living in the community, vaccination against influenza is associated with reductions in the rate of hospitalization and in deaths from influenza and its complications, as compared with the rates in unvaccinated elderly persons, and vaccination produces direct dollar savings.     

External watchman routes

We consider the problem of finding a shortest watchman route from which the exterior of a polygon is visible (external watchman route). We present an O (n ⁴ log logn) algorithm to find shortest external watchman routes for simple polygons by transforming the external watchman route problem to a set of internal watchman route problems. Also, we present faster external watchman route algorithms for special cases. These include optimal O (n) algorithms for convex, monotone, star and spiral polygons and an O (n log logn) algorithm for rectilinear polygons.This work was supported in part by a grant from Texas Instruments, Inc. to S. Ntafos     

Increasing breast and cervical cancer screening in low-income women

Active cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) was treated with an intraocular sustained-release ganciclovir implant. A total number of 19 implants were performed in 15 eyes of 9 AIDS patients. The intraocular sustained-release ganciclovir was effective in preventing reactivation of CMV retinitis in 15 of the 19 implants, ineffective in 3, and undetermined in 1. All ineffective cases had been resistant to ganciclovir therapy before the implants. Vision after the therapy was maintained at better than 0.5 except for one eye. There were no serious ocular complications caused by the therapy. Among 5 patients with unilateral CMV retinitis, 2 unaffected eyes developed CMV retinitis during this therapy. In addition, another patient developed presumed CMV infection in other systemic organs. Based on these data, the intraocular sustained-release ganciclovir implant was considered to be useful for the treatment of CMV retinitis in AIDS.     

Adaptive isogeometric analysis by local h-refinement with T-splines

Isogeometric analysis based on non-uniform rational B-splines (NURBS) as basis functions preserves the exact geometry but suffers from the drawback of a rectangular grid of control points in the parameter space, which renders a purely local refinement impossible. This paper demonstrates how this difficulty can be overcome by using T-splines instead. T-splines allow the introduction of so-called T-junctions, which are related to hanging nodes in the standard FEM. Obeying a few straightforward rules, rectangular patches in the parameter space of the T-splines can be subdivided and thus a local refinement becomes feasible while still preserving the exact geometry. Furthermore, it is shown how state-of-the-art a posteriori error estimation techniques can be combined with refinement by T-splines. Numerical examples underline the potential of isogeometric analysis with T-splines and give hints for further developments.     

Multifrequency tympanometry in chinchillas

Multifrequency tympanometry (MFT), using probe frequencies ranging from 226-2,000 Hz, was performed on normal chinchillas to obtain normative data against which to compare results from animals with middle ear pathology. A series of validating experiments was conducted to determine the effects of anatomical alterations of the middle ear on MFT. These included artificially extending the ear canal, opening the bulla, injecting saline into the middle ear, and disrupting the ossicular chain. The results indicate that MFT characteristics of chinchilla ears are qualitatively similar to those observed in normal humans and patients with middle ear disease, and MFT provides information that is not available from the 226-Hz tympanogram.     

Source of the Difference between the Measurement of Water in Hydrocarbons As Determined by the Volumetric and Coulometric Karl Fischer Methods

The disparity between the volumetric and coulometric Karl Fischer methods for the measurement of water in hydrocarbons and hydrocarbon mixtures (oils) has been resolved. The amount of water detected by the volumetric method when the titration vessel solution is homogeneous is higher than that measured coulometrically or volumetrically when the titration vessel solution is heterogeneous. Water in oil that is not measured by the coulometric method when the oil is incompletely dissolved has been shown to reside in the oil phase of the heterogeneous (multiphasic) coulometric vessel suspension. Water that is not measured volumetrically under relatively low chloroform concentrations after the point of transition to a heterogeneous titration vessel solution is reached also appears to reside in the nonaqueous phase of the titration vessel solution. It appears that this water is retained in the hydrocarbon phase in a manner such that it is completely inaccessible to the volumetric or coulometric Karl Fischer reagents.