Medicine and Health Sciences Commons^™

Statistical Issues In Proteomic Research, Jeffrey S. Morris

Jeffrey S. Morris

No abstract provided.

Systemic And Mucosal Infection Program Protective Memory Cd8 T Cells In The Vaginal Mucosa., Thandi M. Onami, P. K. Suvas, H. M. Dech, J. Zeng

Thandi M. Onami

Whether mucosal immunization is required for optimal protective CD8 T cell memory at mucosal surfaces is controversial. In this study, using an adoptive transfer system, we compare the efficacy of two routes of acute lymphocytic choriomeningitis viral infection on the generation, maintenance, and localization of Ag-specific CD8 T cells in tissues, including the vaginal mucosa. Surprisingly, at day 8, i.p. infection results in higher numbers of Ag-specific CD8 T cells in the vaginal mucosa and iliac lymph node, as well as 2-3x more Ag-specific CD8 T cells that coexpress both IFN-gamma and TNF-alpha in comparison to the intranasal route of …

Weight, Mortality, Years Of Healthy Life, And Active Life Expectancy In Older Adults, Paula Diehr

Paula Diehr

OBJECTIVES: To determine whether weight categories predict subsequent mortality and morbidity in older adults. DESIGN: Multistate life tables, using data from the Cardiovascular Health Study, a longitudinal population-based cohort of older adults. SETTING: Data were provided by community-dwelling seniors in four U.S. counties: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania. PARTICIPANTS: Five thousand eight hundred eighty-eight adults aged 65 and older at baseline. MEASUREMENTS: The age- and sex-specific probabilities of transition from one health state to another and from one weight category to another were estimated. From these probabilities, future life expectancy, years …

Librarian Outreach: Better Research For Better Careers, Todd Prusin

Todd Prusin

Medical librarianship is changing in healthcare environments. Since 1996, by which time the standards that determine how hospitals acquire accreditation changed, many hospitals are acquiring accreditation without a qualified medical librarian on site. For that reason, it has become even more important that healthcare professionals, doctors, nurses and other clinicians, learn to access and evaluate quality information as an integral part of their academic training. Because of this, medical clinicians must begin their careers with strong research skills. These skills must be attained during their academic matriculation and studies in the field of librarianship have shown that departmental outreach hours …

The Number Of Sick Persons In A Cohort, Paula Diehr

Paula Diehr

To see if the number of sick persons in a cohort was approximately constant over time, we calculated the number of sick persons in a “research” cohort of older adults followed for up to 14 years, and also in a synthetic birth cohort. Methods: In the research cohort, we calculated the actual number of persons in each health state over time, using eight different definitions of “sick”. For the birth cohort, we estimated the number of sick persons each year after birth. Results: The number of sick persons in the research cohort was approximately constant for 14 years, for all …

History-Adjusted Marginal Structural Models To Estimate Time-Varying Effect Modification, Maya Petersen, Steven Deeks, Jefferey Martin, Mark Van Der Laan

Maya Petersen

Much of epidemiology and clinical medicine is focused on the estimation of treatments or interventions administered over time. In such settings of longitudinal treatment, time-dependent confounding is often an important source of bias. Marginal structural models are a powerful tool for estimating the causal effect of a treatment using observational data, particularly when time-dependent confounding is present. Recent statistical work presented a generalization of marginal structural models, called history-adjusted marginal structural models. Unlike standard marginal structural models, history-adjusted marginal structural models can be used to estimate modification of treatment effects by time-varying covariates. Estimation of time-dependent causal effect modification is …

Statistical Methods For Analyzing Sequentially Randomized Trials, Oliver Bembom, Mark J. Van Der Laan

Oliver Bembom

In this issue of JNCI, Thall et al. present the results of a clinical trial that makes use of sequential randomization, a novel trial design that allows the investigator to study adaptive treatment strategies. Our aim is to complement this groundbreaking work by reviewing the current state of the art of statistical methods available for such analyses. Using the data collected by Thall et al. as an example, we focus on two different approaches for estimating the success rates of different adaptive treatment strategies of interest. By emphasizing the intuitive appeal and straightforward implementation of these methods and illustrating the …

The Potential Role Of Probiotics In Reducing Poverty-Associated Infections In Developing Countries, Kingsley C. Anukam

Kingsley C Anukam

Probiotics are defined by the Food and Agricultural Organization/ World Health Organization as “live microorganisms which when administered in adequate amounts confer a health benefit on the host” [1]. The potential benefits of their use have not been adequately investigated, especially in the developing world. Japan introduced Yakult, a probiotic fermented food drink in 1935, and in the Northern hemisphere, research and use of probiotics has gained an unprecedented momentum in the last decade [2]. Use of probiotics is not uncommon in Europe [3], but in many developing countries use of probiotics in its present definition is a foreign concept. …

Managing A Widespread E-Procurement Implementation In Public Healthcare, Tommaso Federici, Andrea Resca

Federici Tommaso

In large parts of Europe, the development of healthcare is subject to contrasting forces. On the one hand, there has been an explosion in spending and, at the same time, governments are faced with strict budget constraints. On the other hand, public healthcare is under pressure to be innovative, technologically advanced and to provide increasingly better quality of services. In this context, eprocurement can be seen as an instrument to offer a solution to the first issue of this dilemma. However, e-procurement initiatives in such domain have not been widely deployed, and most of them have not fully delivered the …

The Effect Of Faith Or Spirituality In Pregnancy: A Content Analysis, Darlene Elizabeth Jesse

D. Elizabeth Jesse

This study used a qualitative descriptive research design to discover the relevance and meaning of spirituality in the lives of 130 urban low-income pregnant women by asking the open-ended question, “How does your faith or spirituality affect your pregnancy if at all?” Forty-seven percent of the women in this study described how spirituality affected their pregnancy positively, 45% described that spirituality did not affect them, and 5.4% were unsure. A content analysis of those who answered positively revealed six themes from the data describing the meaning of faith or spirituality in pregnancy: (a) guidance and support; (b) protection, blessing, or …

Smoking Cessation In Later Life: An Evaluation Of The Impact Of Smoking Cessation Training On The Knowledge, Attitudes And Practice Of Members Of The Primary Care Team Who Work With Older People, Susan M. Kerr, Rosemary Whyte, Hazel Watson, Debbie Tolson, Angus Mcfadyen K

Dr. Susan Kerr

1. Introduction

Smokers aged 65 years and older are a vulnerable group who are likely to have conditions that are caused or complicated by smoking. Older smokers are also likely to die prematurely, losing on average 16 years from their projected life expectancy.

In recent years a growing body of research has demonstrated that older smokers can derive significant health benefits from stopping smoking in later life, despite having smoked for many years. The benefits of cessation are almost immediate for conditions such as heart disease and stroke. Stopping smoking also reduces the risk of developing cancer and stabilises existing …

Age-Specific Prevalence And Years Of Healthy Life In A System With 3 Health States, Paula Diehr

Paula Diehr

Consider a 3-state system with one absorbing state, such as Healthy, Sick, and Dead. Over time, the prevalence of the Healthy state will approach an 'equilibrium' value that is independent of the initial conditions. We derived this equilibrium prevalence (Prev:Equil) as a function of the local transition probabilities. We then used Prev:Equil to estimate the expected number of years spent in the healthy state over time. This estimate is similar to the one calculated by multi-state life table methods, and has the advantage of having an associated standard error. In longitudinal data for older adults, the standard error was accurate …

Smallpox, Richard N. Bradley

Richard N Bradley

Description Viral infection of the human respiratory tract. Causes Infection by variola virus. Risk Factors Exposure to a biological warfare or bioterror attack or contact with an infected person. Symptoms

Fever, cough and body aches, followed by a spotted, bumpy rash.

Diagnosis

Confirmed by testing blood or the fluid from the blisters.

Treatments

None currently approved but experts are testing some medications.

Pathogenesis

The virus enters and multiplies in the respiratory passages.

Prevention

Avoid those with the disease. During an outbreak a vaccine is available that will prevent the disease or lessen its severity.

Epidemiology

Completely eradicated from nature, but …

Aids-Defining Illnesses: A Comparison Between Before And After Commencement Of Highly Active Antiretroviral Therapy (Haaart), Yvonne Lim Ai Lian

Yvonne Lim Ai Lian

Attempts to address the significant impact of HAART on medical variables on the Malaysian HIV/AIDS population have yet to be evaluated. This study aims to analyze the proportions of AIDS-defining illnesses (ADIs) before and after HAART. A retrospective study was carried out on 128 new cases of HIV infected patients who first commenced HAART in 2004 at the national HIV reference center. Before commencement of HAART, 76 clinical episodes of ADIs were recorded in 52 patients. Most common being pulmonary Mycobacterium tuberculosis (28.9%), PCP (27.6%) and disseminated and extrapulmonary Mycobacterium tuberculosis (11.8%). During HAART, 8 clinical episodes of ADIs were …

Role Of N-Epsilon-(Carboxymethyl)Lysine In The Development Of Ischemic Heart Disease In Type 2 Diabetes Mellitus, Ikram Shah Ismail

Ikram Shah Ismail

This study aims to determine the levels of N-epsilon-(carboxymethyl)lysine (CML) in patients with Type 2 diabetic patients with and without ischemic heart disease (IHD) and to find for a possible association between circulating CML and a number of clinical parameters including lipids, hemoglobin Ale (HbA1c) and malondialdehyde (NIDA) in Type 2 diabetic 1111) patients. Serum CML levels were measured by enzyme-linked immunosorbent assay using polyclonal anti-CML antibodies. Serum levels of CML and NIDA were assessed in 60 IHD patients with Type 2 diabetes, 43 HID patients without Type 2 diabetes, 64 Type 2 diabetics without IHD, and 80 sex- and …

More Than Meets The Eye: The Import Of Retail Cigarette Merchandising, Richard W. Pollay

Richard W. Pollay

No abstract provided.

Antiviral Activity Of Aloe Vera Against Herpes Simplex Virus Type 2: An In Vitro Study, Keivan Zandi

Keivan Zandi

In this study we tested the antiviral activity of a crude hot glycerine extract of Aloe vera gel which was grown in Bushehr (Southwest of Iran) against HSV-2 replication in Vero cell line. The extract showed antiviral activity against HSV-2 not only before attachment and entry of virus to the Vero cells but also on post attachment stages of virus replication. The IC50 before attachment and entry of virus to the cells is 428 mu g/ml and the CC50 value which is the cytotoxicity of the extract for Vero cells is 3238 mu g/ml, while the calculated selectivity index (SI) …

Biomarker Discovery Using Targeted Maximum Likelihood Estimation: Application To The Treatment Of Antiretroviral Resistant Hiv Infection, Oliver Bembom, Maya L. Petersen, Soo-Yon Rhee, W. Jeffrey Fessel, Sandra E. Sinisi, Robert W. Shafer, Mark J. Van Der Laan

Oliver Bembom

Researchers in clinical science and bioinformatics frequently aim to learn which of a set of candidate biomarkers is important in determining a given outcome, and to rank the contributions of the candidates accordingly. This article introduces a new approach to research questions of this type, based on targeted maximum likelihood estimation of variable importance measures. The methodology is illustrated using an example drawn from the treatment of HIV infection. Specifically, given a list of candidate mutations in the protease enzyme of HIV, we aim to discover mutations that reduce clinical virologic response to antiretroviral regimens containing the protease inhibitor lopinavir. …

Midwifery Education And Maternal And Neonatal Health Issues: Challenges In Pakistan, Tazeen S. Ali Dr, Beth Mcmanis Dr, Rafat Jan Rukanuddin Dr

Tazeen S Ali Dr

neonatal mortality rates still remain a challenge. Developed countries have reduced maternal and neonatal mortality rates by improving the skill and knowledge levels of nurse-midwives. This paper reviews maternal and neonatal health issues, challenges in current midwifery education, and the role of government and international agencies in Pakistan. The exact maternal and neonatal mortality rates in Pakistan are unknown; a census has not occurred since 1998, and data provided in more recent studies were presented in summary format. A number of factors that contribute to the high mortality rate could easily be controlled by using competent nurse-midwives throughout all levels …

Virologic Efficacy Of Boosted Double Vs. Boosted Single Protease Inhibitor Therapy., Maya Petersen, Yue Wang, Mark Van Der Laan, Soo-Yon Rhee, Robert Shafer, W. Jefferey Fessel

Maya Petersen

Objective: Although regimens containing two protease inhibitor (PI) together with ritonavir boosting are used with the aim of improving virologic response to salvage therapy, there is little evidence to support or reject this approach. We compared the probability of attaining an undetectable HIV RNA level after using either boosted double or boosted single PI regimens. Design: Retrospective clinical cohort. Methods: PI-experienced subjects in a Northern California-based database who initiated either a boosted single or boosted double PI salvage therapy regimen were analysed. Traditional multivariable regression and marginal structural model analyses were used to compare the effects of the two regimens …

Are Unhygienic Practices During The Menstrual, Partum And Postpartum Periods Risk Factors For Secondary Infertility?, Tazeen S. Ali Dr, Neelofar Sami Dr, Ali Khan Khuwaja Dr

Tazeen S Ali Dr

This study was aimed at identifying practices during the menstrual, partum and postpartum periods posing possible risk factors contributing towards secondary infertility in women of a selected population in Karachi, Pakistan. A matched case-control study was conducted from April 2003 to March 2004. Four hundred cases were selected from five infertility clinics affiliated with tertiary-care hospitals, and 400 age-matched controls were recruited from the neighborhood of each case. After taking written consents, trained interviewers conducted interviews using a pretested structured questionnaire. Factors found to be independently associated with secondary infertility were: previous delivery at an unclean place (adjusted odds ratio …

Collective Creativity: Ideas For The Super Library Organism, Lisa Forrest, Dennis Reed

Lisa A Forrest

No abstract provided.

Assessing Chronic Disease Management Strategies Through Community Based Participatory Research, Kevin D. Willison

Kevin D Willison

Comprehensive chronic disease management (CDM) strategies aim to improve such aspects as continuity of care, health-related quality of life and, overall population health. Here, consideration is made of how CDM may be enhanced through a more integrated and holistic health care system by incorporating a community based participatory research (CBPR) approach. This has the potential to provide meaningful participation by citizens in public health policy development. That CBPR may garner improved assessment of the effectiveness of existing CDM strategies, as imbedded in such practices as (regulated) complementary/alternative medicine (CAM), public health, and transcultural health care initiatives, should not be overlooked.

Data-Adaptive Estimation Of The Treatment-Specific Mean, Yue Wang, Oliver Bembom, Mark Van Der Laan

Oliver Bembom

An important problem in epidemiology and medical research is the estimation of the causal effect of a treatment action at a single point in time on the mean of an outcome, possibly within strata of the target population defined by a subset of the baseline covariates. Current approaches to this problem are based on marginal structural models, i.e. parametric models for the marginal distribution of counterfactual outcomes as a function of treatment and effect modifiers. The various estimators developed in this context furthermore each depend on a high-dimensional nuisance parameter whose estimation currently also relies on parametric models. Since misspecification …

Estimating The Effect Of Vigorous Physical Activity On Mortality In The Elderly Based On Realistic Individualized Treatment And Intention-To-Treat Rules, Oliver Bembom, Mark J. Van Der Laan

Oliver Bembom

The effect of vigorous physical activity on mortality in the elderly is difficult to estimate using conventional approaches to causal inference that define this effect by comparing the mortality risks corresponding to hypothetical scenarios in which all subjects in the target population engage in a given level of vigorous physical activity. A causal effect defined on the basis of such a static treatment intervention can only be identified from observed data if all subjects in the target population have a positive probability of selecting each of the candidate treatment options, an assumption that is highly unrealistic in this case since …

Analyzing Sequentially Randomized Trials Based On Causal Effect Models For Realistic Individualized Treatment Rules, Oliver Bembom, Mark J. Van Der Laan

Oliver Bembom

In this paper, we argue that causal effect models for realistic individualized treatment rules represent an attractive tool for analyzing sequentially randomized trials. Unlike a number of methods proposed previously, this approach does not rely on the assumption that intermediate outcomes are discrete or that models for the distributions of these intermediate outcomes given the observed past are correctly specified. In addition, it generalizes the methodology for performing pairwise comparisons between individualized treatment rules by allowing the user to posit a marginal structural model for all candidate treatment rules simultaneously. If only a small number of candidate treatment rules are …

Effects Of Angiotensin 1-7 On The Actions Of Angiotensin Ii In The Renal And Mesenteric Vasculature Of Hypertensive And Streptozotocin-Induced Diabetic Rats, Mohd Rais Mustafa, Murugan Dharmani, Francis I. Achike, Meng-Kwoon Sim

Mohd Rais Mustafa

Angiotensin 1-7, a heptapeptide derived from metabolism of either angiotensin I or angiotensin II, is a biologically active peptide of the renin–angiotensin system. The present study investigated the effect of angiotensin 1-7 on the vasopressor action of angiotensin II in the renal and mesenteric vasculature of Wistar-Kyoto (WKY) rats, spontaneously hypertensive rats (SHR) and streptozotocin-induced diabetic rats. Angiotensin II-induced dose-dependent vasoconstrictions in the renal vasculature. The pressor response was enhanced in the SHR and reduced in the streptozotocin-diabetic rat compared to WKY rats. Angiotensin 1-7 attenuated the angiotensin II pressor responses in the renal vasculature of WKY and SHR rats. …

Towards E-Health: National Access To Electronic Health Information, Lindsay K. Harris

Lindsay Harris

Health Libraries Australia has made a sustained effort to advance the development of a national approach to the delivery of electronic health information since holding a national forum back in 2003. Lindsay Harris plots the progress to date.

Outsourcing The Packaging Function, Rihaz Z. Chughatta

Rihaz Z Chughatta

If you are currently working in the packaging department of a major corporation in the pharmaceutical, food or consumer products industry, you have probably been exposed to some form of outsourcing, which is a global trend that has emerged over the past decade, and continues to evolve, within the packaging field.

Exposure Control & Post Exposure Testing And Treatment Of Medical Students Exposed To Hazardous Body Fluids And Tissues, Vikas Singh

Vikas Singh

Institute of Medical Sciences (IMS), Little Rock, Arkansas, is one of the largest employers in state of Arkansas with almost 6000 employees, 1000 physicians, 600 residents, and 1500 students who study and/or provide medical care to patients at the IMS Medical Center, and other affiliate hospital of IMS at various locations throughout the state.

IMS, Occupational Health & Safety Department works in close conjunction with various other departments and advisory boards, to formulate policies, protocols and procedures, guidelines, safety training programs and education for hazard control and mitigation. It reviews its policies and plans on yearly basis to be in …