Medicine and Health Sciences Commons^™

Diagnostic Surgical Pathology: The Importance Of Second Opinion In A Developing Country, Z. Ahmed, N. Yaqoob, S. Muzaffar, N. Kayani, Shahid Pervez, S. H. Hasan

Department of Pathology and Laboratory Medicine

Objective: To review the cases sent to the section of histopathology, Aga Khan Universty (AKU) for second opinion and see whether there are significant differences in the original outside diagnosis and the subsequent diagnosis submitted by us.

Methods: A retrospective study of all consecutive cases for second opinion in the form of paraffin blocks from 1st Novemver 2001 to 31st July 2002. The primary submitted diagnosis in each case was compared with the subsequent AKU diagnosis.

Results: The study included a total of 381 cases. However, in 45 cases (11.81%), initial histopathological diagnosis was not provided. Out of the remaining …

Effect Of Ketorolac On Postoperative Pain Relief In Dental Extraction Cases--A Comparative Study With Pethidine, S M. Abbas, R S. Kamal, G Afshan

Department of Anaesthesia

Objective: To compare the analgesic efficacy and side effects of ketorolac with pethidine in a day care procedure.STUDY Design: Single dose, double blind, case matched study.Methods: Sixty patients were divided into group A and group B, who received either ketorolac 30 mg or Pethidine 0.8 mg/kg ( both IN ) respectively at the time of induction of general anaesthesia. Patients were assessed in recovery room for pain according to visual analogue scale and any side effects. Amount of rescue analgesia required by both groups were also recorded. Odds Ratio and and Chi Square test were used for statistical analysis.Results: Statistical …

Jefferson Alumni Bulletin – Volume 53, Number 3, June 2004

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Jefferson Alumni Bulletin – Volume 53, Number 3, June 2004 Robert L. Barchi MD PhD Is Named President of Thomas Jefferson University; Page 4 The Importance of Mentors: David's Story by Dean Thomas J. Nasca ’75; Page 6 The Center for Human Virology: Confronting the Whole Spectrum of Epidemics; Page 8 Jefferson Selected to Develop Response to Bioterrorism; Page 10 Four Students Win AOA Community Service Award; Page 11 Stories from Iraq and Afghanistan; Page 12 New Book about the Nationally Recognized Physician Shortage Area Program; Page 16

Multiple Testing To Establish Superiority/Equivalence Of A New Treatment Compared With K Standard Treatments For Unbalanced Designs, Koon Shing Kwong, Siu Hung Cheung, Wai-Sum Chan

Research Collection School Of Economics

In clinical studies, multiple superiority/equivalence testing procedures can be applied to classify a new treatment as superior, equivalent (same therapeutic effect), or inferior to each set of standard treatments. Previous stepwise approaches (Dunnett and Tamhane, 1997, Statistics in Medicine 16, 2489–2506; Kwong, 2001, Journal of Statistical Planning and Inference 97, 359–366) are only appropriate for balanced designs. Unfortunately, the construction of similar tests for unbalanced designs is far more complex, with two major difficulties: (i) the ordering of test statistics for superiority may not be the same as the ordering of test statistics for equivalence; and (ii) the correlation structure …

Brighter Noise: Sensory Enhancement Of Perceived Loudness By Concurrent Visual Stimulation, Yoav Arieh, Eric C. Odgaard, Lawrence E. Marks

Department of Psychology Faculty Scholarship and Creative Works

Two experiments investigated the effect of concurrently presented light on the perceived loudness of a low-level burst of white noise. The results suggest two points. First, white noise presented with light tends to be rated as louder than noise presented alone. Second, the enhancement in loudness judgments is resistant to two experimental manipulations: varying the probability that light accompanies sound and shifting from a rating method to a forced choice comparison. Both manipulations were previously shown to eliminate a complementary noise-induced enhancement in ratings of brightness. Whereas noise-induced enhancement of brightness seems to reflect a late-stage decisional process, such as …

Operative Treatment Of Bilateral Hip Dislocation In Children With Arthrogryposis Multiplex Congenita, S Asif, Masood Umer, Rashid Baig

Department of Surgery Docs

Abstract

PURPOSE:

Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. It is commonly believed that bilaterally dislocated hips associated with joint contractures should not be reduced, because movement is satisfactory, while open reduction leads to poor results. This report presents our experience with surgical management of bilateral dislocation of hips in children with AMC.

METHODS:

During the period 1990 to 2000, we performed open reduction on 8 hips of 4 children with AMC. The mean age at surgery was 23 months (range, 5-48 months). Open reduction and capsular plication without any bony procedure were performed in …

Percutaneous Embolisation And Transverse Myelitis: A Rare Association, O Ashraf, F Aslam, M Irfan, A B. Zubairi, M Azeemuddin

Department of Radiology

No abstract provided.

Bronchiolitis Obliterans Organizing Pneumonia Associated With Cytomegalovirus Infection In A Patient With Systemic Lupus Erythematosus., Muhammad Irfan, Ali Bin Sarwar Zubairi, S.J. Husain

Department of Medicine

No abstract provided.

Post-Irradiation Leiomyosarcoma Of The Maxilla: Report Of A Case In A Patient With Prior Radiation Treatment For Retinoblastoma, Parish P. Sedghizadeh, Francesca Angiero, Carl M. Allen, John R. Kalmar, Yeshwant B. Rawal, Eric A. Albright

School of Dentistry Faculty Research and Publications

Post-irradiation sarcoma is a well-defined complication of radiation therapy, yet few reports document such lesions in the head and neck. A 30-year-old man presented for evaluation of an expansile lesion of the left posterior maxilla. His medical history was significant for a childhood ocular malignancy - unilateral retinoblastoma - which was treated with a combination of surgical enucleation of the eye and external beam radiation therapy. Biopsy of his maxillary lesion revealed a spindle cell malignancy that was morphologically and immunohistochemically consistent with a diagnosis of leiomyosarcoma. Further investigation into the case revealed that the patient had three children, every …

Master Plumber Dies When Trench Collapses, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Other

On July 29, 2003, a 35-year-old, male master plumber died when an unshorn trench collapsed. Two employees from the contracting company were speaking with him at the time from the side of the trench. He had searched and diagnosed a water line leak when the walls of the trench collapsed. The plumber was employed by a plumbing company contracted by a commercial establishment to locate and repair a water leak. He died at the scene from asphyxia due to chest compression.

To prevent future occurrences of similar incidents, the following recommendations have been made:

Recommendation No. 1: Employers should train …

Seasonal Analyses Of Air Pollution And Mortality In 100 U.S. Cities, Roger D. Peng, Francesca Dominici, Roberto Pastor-Barriuso, Scott L. Zeger, Jonathan M. Samet

Johns Hopkins University, Dept. of Biostatistics Working Papers

Time series models relating short-term changes in air pollution levels to daily mortality counts typically assume that the effects of air pollution on the log relative rate of mortality do not vary with time. However, these short-term effects might plausibly vary by season. Changes in the sources of air pollution and meteorology can result in changes in characteristics of the air pollution mixture across seasons. The authors develop Bayesian semi-parametric hierarchical models for estimating time-varying effects of pollution on mortality in multi-site time series studies. The methods are applied to the updated National Morbidity and Mortality Air Pollution Study database …

Roofing Laborer Dies After 60-Foot Fall, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Falls

At 8:00 AM on the morning of October 7, 2003, a 33-year-old laborer, working for a roofing contractor, was removing debris from a commercial building roof when he slipped and fell 60 feet to the sidewalk below. There were 2 other laborers and the contractor at the work site that morning. It was the second work day at this particular job site and the three workers were to finish discarding bags of debris from the roof. The decedent and one of the laborers accessed the roof through the building interior, up a flight of stairs to a five-step ladder which …

Predicting The Use Of Personal Respiratory Protection Among Workers In Swine Confinement Buildings, M. Susan Jones

Nursing Faculty Publications

The purpose of this study was to identify the variables that influence the frequency of personal respiratory protection (PRP) use by workers in swine confinement buildings (SCBs). The study was designed to answer four research questions: 1). What is the validity and reliability of the Personal Respiratory Protection Survey (PRPS)? 2). How frequently do workers in SCBs wear PRP? 3). How do demographics, occupational histories, and self-reported respiratory health histories influence the use of PRP in SCBs? and 4). What are the relationships of the constructs (benefits, barriers, susceptibility, severity, norms) to the use of PRP by workers in SCBs? …

The Economics Of Quality: Changing Incentives In Cincinnati, Lisa Sprague, Nora Super

National Health Policy Forum

This site visit focused on private market dynamics and quality improvement initiatives. Cincinnati is characterized by strong players in all sectors of the market: employers such as Procter and Gamble and General Electric, hospital systems, health plans, and physician groups with the power to “push back” in contract negotiations. The city is a pilot site for Bridges to Excellence, a pay-for-performance initiative spearheaded by GE. Cincinnati Children’s Hospital Medical Center is a grantee under the Robert Wood Johnson Foundation’s Pursuing Perfection program. Among the issues explored were physician supply, incentive structures, specialty hospitals, and information technology.

2004 Commencement For Jefferson College Of Health Professions And Jefferson College Of Graduate Studies

Jefferson College of Nursing Commencements

No abstract provided.

Rabies In Newfoundland & Labrador

Zoonotics and Wildlife Disease: Publications

Rabies is a deadly viral disease of the brain spread by the bite of infected mammals. It is most commonly seen in red or arctic foxes in this province though other wild animals such as bats may carry the disease. Sick foxes can bite other foxes, dogs, cats, wolves, caribou, other animals and people and make them sick. Once bitten by an animal with rabies it can take from two weeks to six months before the animal shows signs of the disease. Though uncommon, this period can be as short as 4 days or as long as a year or …

Endogenous No Regulates Superoxide Production At Low Oxygen Concentrations By Modifying The Redox State Of Cytochrome C Oxidase, Miriam Palacios-Callender, Marisol Quintero, Veronica S. Hollis, Roger J. Springett, Salvador Moncada

Dartmouth Scholarship

We have investigated in whole cells whether, at low oxygen concentrations ([O(2)]), endogenous nitric oxide (NO) modulates the redox state of the mitochondrial electron transport chain (ETC), and whether such an action has any signaling consequences. Using a polarographic-and-spectroscopic-coupled system, we monitored redox changes in the ETC cytochromes b(H), cc(1), and aa(3) during cellular respiration. The rate of O(2) consumption (VO(2)) remained constant until [O(2)] fell below 15 microM, whereas the onset of reduction of cytochromes aa(3), part of the terminal ETC enzyme cytochrome c oxidase, occurred at approximately 50 microM O(2). Incubation of the cells with an inhibitor of …

Nonparametric And Semiparametric Inference For Models Of Tumor Size And Metastasis, Debashis Ghosh

The University of Michigan Department of Biostatistics Working Paper Series

There has been some recent work in the statistical literature for modelling the relationship between the size of primary cancers and the occurrences of metastases. While nonparametric methods have been proposed for estimation of the tumor size distribution at which metastatic transition occurs, their asymptotic properties have not been studied. In addition, no testing or regression methods are available so that potential confounders and prognostic factors can be adjusted for. We develop a unified approach to nonparametric and semiparametric analysis of modelling tumor size-metastasis data in this article. An equivalence between the models considered by previous authors with survival data …

Model Checking Techniques For Regression Models In Cancer Screening, Debashis Ghosh

The University of Michigan Department of Biostatistics Working Paper Series

There has been much work on developing statistical procedures for associating tumor size with the probability of detecting a metastasis. Recently, Ghosh (2004) developed a unified statistical framework in which equivalences with censored data structures and models for tumor size and metastasis were examined. Based on this framework, we consider model checking techniques for semiparametric regression models in this paper. The procedures are for checking the additive hazards model. Goodness of fit methods are described for assessing functional form of covariates as well as the additive hazards assumption. The finite-sample properties of the methods are assessed using simulation studies.

Binary Isotonic Regression Procedures, With Application To Cancer Biomarkers, Debashis Ghosh, Moulinath Banerjee, Pinaki Biswas

The University of Michigan Department of Biostatistics Working Paper Series

There is a lot of interest in the development and characterization of new biomarkers for screening large populations for disease. In much of the literature on diagnostic testing, increased levels of a biomarker correlate with increased disease risk. However, parametric forms are typically used to associate these quantities. In this article, we specify a monotonic relationship between biomarker levels with disease risk. This leads to consideration of a nonparametric regression model for a single biomarker. Estimation results using isotonic regression-type estimators and asymptotic results are given. We also discuss confidence set estimation in this setting and propose three procedures for …

Semiparametic Models And Estimation Procedures For Binormal Roc Curves With Multiple Biomarkers, Debashis Ghosh

The University of Michigan Department of Biostatistics Working Paper Series

In diagnostic medicine, there is great interest in developing strategies for combining biomarkers in order to optimize classification accuracy. A popular model that has been used for receiver operating characteristic (ROC) curve modelling when one biomarker is available is the binormal model. Extension of the model to accommodate multiple biomarkers has not been considered in this literature. Here, we consider a multivariate binormal framework for combining biomarkers using copula functions that leads to a natural multivariate extension of the binormal model. Estimation in this model will be done using rank-based procedures. We show that the Van der Waerden rank score …

Ada News - 05/17/2004, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

Test-Retest Reliability Of Temporal And Spatial Gait Characteristics Measured With An Instrumented Walkway System (Gaitrite®), Cornelius J.T. Van Uden, Marcus P. Besser

Department of Physical Therapy Faculty Papers

Background
The purpose of this study was to determine the test-retest reliability of temporal and spatial gait measurements over a one-week period as measured using an instrumented walkway system (GAITRite®).

Methods
Subjects were tested on two occasions one week apart. Measurements were made at preferred and fast walking speeds using the GAITRite® system. Measurements tested included walking speed, step length, stride length, base of support, step time, stride time, swing time, stance time, single and double support times, and toe in-toe out angle.

Results
Twenty-one healthy subjects participated in this study. The group consisted of 12 men and 9 women, …

Test-Retest Reliability Of Temporal And Spatial Gait Characteristics Measured With An Instrumented Walkway System (Gaitrite)., Cornelis J T Van Uden, Marcus P Besser

Department of Physical Therapy Faculty Papers

BACKGROUND: The purpose of this study was to determine the test-retest reliability of temporal and spatial gait measurements over a one-week period as measured using an instrumented walkway system (GAITRite). METHODS: Subjects were tested on two occasions one week apart. Measurements were made at preferred and fast walking speeds using the GAITRite system. Measurements tested included walking speed, step length, stride length, base of support, step time, stride time, swing time, stance time, single and double support times, and toe in-toe out angle. RESULTS: Twenty-one healthy subjects participated in this study. The group consisted of 12 men and 9 women, …

Consumer Cost Sharing In Private Health Insurance: On The Threshold Of Change, Veronica V. Goff

National Health Policy Forum

Employers are asking employees to pay more for health care through higher premium contributions, share of contribution, and out-of-pocket maximums, along with variations in deductibles, copays, and coinsurance based on choice of providers, networks, drugs, and other services. This issue brief examines consumer cost-sharing trends in private insurance, discusses the outlook for cost sharing in employment-based benefits, and considers public policies to support health care markets for consumers.

Methods To Impair Hematologic Cancer Progenitor Cells And Compounds Related Thereto, Craig Jordan

Internal Medicine Faculty Patents

Primitive or progenitor hematologic cancer cells have been implicated in the early stages and development of leukemia and malignant lymphoproliferative disorders, including acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML) and chronic lymphoid leukemia (CLL). Interleukin-3 receptor alpha chain (IL-3Rα or CD123) is strongly expressed on progenitor hematologic cancer cells, but is virtually undetectable on normal bone marrow cells. The present invention provides methods of impairing progenitor hematologic cancer (e.g., leukemia and lymphomic) cells by selectively targeting cells expressing CD123. These methods are useful in the detection and treatment of leukemias and malignant lymphoproliferative disorders. Also provided are compounds useful …

Medicare's Chronic Care Improvement Pilot Program: What Is Its Potential?, Nora Super

National Health Policy Forum

This paper describes the voluntary chronic care improvement program under traditional fee-for-service Medicare as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173; section 721). This brief analyzes the emerging issues raised by this new program, including which chronic conditions and regional areas will be targeted, the types of entities that may participate, the physician’s role in care management, and the adoption and use of health information technology and evidence-based clinical guidelines.

On Corrected Score Approach For Proportional Hazards Model With Covariate Measurement Error, Xiao Song, Yijian Huang

UW Biostatistics Working Paper Series

In the presence of covariate measurement error with the proportional hazards model, several functional modeling methods have been proposed. These include the conditional score estimator (Tsiatis and Davidian, 2001), the parametric correction estimator (Nakamura, 1992) and the nonparametric correction estimator (Huang and Wang, 2000, 2003) in the order of weaker assumptions on the error. Although they are all consistent, each suffers from potential difficulties with small samples and substantial measurement error. In this article, upon noting that the conditional score and parametric correction estimators are asymptotically equivalent in the case of normal error, we investigate their relative finite sample performance …

Ada News - 05/03/2004, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

The Cell Surface Receptor Slam Controls T Cell And Macrophage Functions, Ninghai Wang, Abhay Satoskar, William Faubion, Susumu Okamoto, Stefan Feske, Charles A. Gullo Phd, Kareem Clarke, Miriam Rodriguez Sosa, Arlene H. Sharpe, Cox Terhorst

Biochemistry and Microbiology

Signaling lymphocyte activation molecule (SLAM), a glycoprotein expressed on activated lymphocytes and antigen-presenting cells, has been shown to be a coregulator of antigen-driven T cell responses and is one of the two receptors for measles virus. Here we show that T cell receptor–induced interleukin (IL)-4 secretion by SLAM−/− CD4+ cells is down-regulated, whereas interferon γ production by CD4+ T cells is only slightly up-regulated. Although SLAM controls production of IL-12, tumor necrosis factor, and nitric oxide in response to lipopolysaccharide (LPS) by macrophages, SLAM does not regulate phagocytosis and responses to peptidoglycan or CpG. Thus, SLAM acts as a coreceptor …