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2012

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Articles 1 - 30 of 59

Full-Text Articles in Biostatistics

Piscine Myocarditis Virus (Pmcv) In Wild Atlantic Salmon Salmo Salar, Torstein Tengs Dr. Dec 2012

Piscine Myocarditis Virus (Pmcv) In Wild Atlantic Salmon Salmo Salar, Torstein Tengs Dr.

Dr. Torstein Tengs

Cardiomyopathy syndrome (CMS) is a severe cardiac disease of sea-farmed Atlantic salmon Salmo salar L., but CMS-like lesions have also been found in wild Atlantic salmon. In 2010 a double-stranded RNA virus of the Totiviridae family, provisionally named piscine myocarditis virus (PMCV), was described as the causative agent of CMS. In the present paper we report the first detection of PMCV in wild Atlantic salmon. The study is based on screening of 797 wild Atlantic salmon by real-time RT-PCR. The samples were collected from 35 different rivers along the coast of Norway, and all individuals included in the study were …


Generalized Estimating Equations, Second Edition.Pdf, James W. Hardin, Joseph M.. Hilbe Dec 2012

Generalized Estimating Equations, Second Edition.Pdf, James W. Hardin, Joseph M.. Hilbe

Joseph M Hilbe

Generalized Estimating Equations, Second edition, updates the best-selling previous edition, which has been the standard text on the subject since it was published a decade ago. Combining theory and application, the text provides readers with a comprehensive discussion of GEE and related models. Numerous examples are employed throughout the text, along with the software code used to create, run, and evaluate the models being examined. Stata is used as the primary software for running and displaying modeling output; associated R code is also given to allow R users to replicate Stata examples. Specific examples of SAS usage are provided in …


Paradoxical Results Of Adaptive False Discovery Rate Procedures In Neuroimaging Studies, Philip T. Reiss, Armin Schwartzman, Feihan Lu, Lei Huang, Erika Proal Nov 2012

Paradoxical Results Of Adaptive False Discovery Rate Procedures In Neuroimaging Studies, Philip T. Reiss, Armin Schwartzman, Feihan Lu, Lei Huang, Erika Proal

Philip T. Reiss

Adaptive false discovery rate (FDR) procedures, which offer greater power than the original FDR procedure of Benjamini and Hochberg, are often applied to statistical maps of the brain. When a large proportion of the null hypotheses are false, as in the case of widespread effects such as cortical thinning throughout much of the brain, adaptive FDR methods can surprisingly reject more null hypotheses than not accounting for multiple testing at all—i.e., using uncorrected p-values. A straightforward mathematical argument is presented to explain why this can occur with the q-value method of Storey and colleagues, and a simulation study shows that …


Prediction Of Radiation Pneumonitis By Dose-Volume Histogram Parameters In Lung Cancer--A Systematic Review, George Rodrigues, Michael Lock, David D'Souza, Edward Yu, Jake Van Dyk Nov 2012

Prediction Of Radiation Pneumonitis By Dose-Volume Histogram Parameters In Lung Cancer--A Systematic Review, George Rodrigues, Michael Lock, David D'Souza, Edward Yu, Jake Van Dyk

Michael Lock

BACKGROUND AND PURPOSE: To perform a systematic review of the predictive ability of various dose-volume histogram (DVH) parameters (V(dose), mean lung dose (MLD), and normal tissue complication probability (NTCP)) in the incidence of radiation pneumonitis (RP) caused by external-beam radiation therapy.

METHODS AND MATERIALS: Studies assessing the relationship between CT-based DVH reduction parameters and RP rate in radically treated lung cancer were eligible for the review. Synonyms for RP, lung cancer, DVH and its associated parameters (NTCP, V(20), V(30), MLD) were combined in a search strategy involving electronic databases, secondary reference searching, and consultation with experts. Individual or group data …


Technology Assessment Of Automated Atlas Based Segmentation In Prostate Bed Contouring, Jeremiah Hwee, Alexander Louie, Stewart Gaede, Glenn Bauman, David D'Souza, Tracy Sexton, Michael Lock, Belal Ahmad, George Rodrigues Nov 2012

Technology Assessment Of Automated Atlas Based Segmentation In Prostate Bed Contouring, Jeremiah Hwee, Alexander Louie, Stewart Gaede, Glenn Bauman, David D'Souza, Tracy Sexton, Michael Lock, Belal Ahmad, George Rodrigues

Michael Lock

BACKGROUND: Prostate bed (PB) contouring is time consuming and associated with inter-observer variability. We evaluated an automated atlas-based segmentation (AABS) engine in its potential to reduce contouring time and inter-observer variability.

METHODS: An atlas builder (AB) manually contoured the prostate bed, rectum, left femoral head (LFH), right femoral head (RFH), bladder, and penile bulb of 75 post-prostatectomy cases to create an atlas according to the recent RTOG guidelines. 5 other Radiation Oncologists (RO) and the AABS contoured 5 new cases. A STAPLE contour for each of the 5 patients was generated. All contours were anonymized and sent back to the …


Adaptive Matching In Randomized Trials And Observational Studies, Mark J. Van Der Laan, Laura Balzer, Maya L. Petersen Nov 2012

Adaptive Matching In Randomized Trials And Observational Studies, Mark J. Van Der Laan, Laura Balzer, Maya L. Petersen

Laura B. Balzer

In many randomized and observational studies the allocation of treatment among a sample of n independent and identically distributed units is a function of the covariates of all sampled units. As a result, the treatment labels among the units are possibly dependent, complicating estimation and posing challenges for statistical inference. For example, cluster randomized trials frequently sample communities from some target population, construct matched pairs of communities from those included in the sample based on some metric of similarity in baseline community characteristics, and then randomly allocate a treatment and a control intervention within each matched pair. In this case, …


A Pooled Analysis Of Smoking And Colorectal Cancer: Timing Of Exposure And Interactions With Environmental Factors Sep 2012

A Pooled Analysis Of Smoking And Colorectal Cancer: Timing Of Exposure And Interactions With Environmental Factors

Shuo Jiao

Background:Considerable evidence suggests that cigarette smoking is associated with a higher risk of colorectal cancer. What is unclear, however, is the impact of quitting smoking on risk attenuation and whether other risk factors for colorectal cancer modify this association. Methods:We performed a pooled analysis of 8 studies, including 6,796 colorectal cancer cases and 7,770 controls to evaluate the association between cigarette smoking history and colorectal cancer risk, and to investigate potential effect modification by other risk factors. Results:Current smokers (OR=1.26, 95% CI=1.11-1.43) and former smokers (OR=1.18, 95% CI=1.09-1.27), relative to never smokers, showed higher risks of colorectal cancer. Former smokers …


Prevalence Of Tick Borne Encephalitis Virus In Tick Nymphs In Relation To Climatic Factors On The Southern Coast Of Norway, Torstein Tengs Dr. Aug 2012

Prevalence Of Tick Borne Encephalitis Virus In Tick Nymphs In Relation To Climatic Factors On The Southern Coast Of Norway, Torstein Tengs Dr.

Dr. Torstein Tengs

BACKGROUND

Tick-borne encephalitis (TBE) is among the most important vector borne diseases of humans in Europe and is currently identified as a major health problem in many countries. TBE endemic zones have expanded over the past two decades, as well as the number of reported cases within endemic areas. Multiple factors are ascribed for the increased incidence of TBE, including climatic change. The number of TBE cases has also increased in Norway over the past decade, and the human cases cluster along the southern coast of Norway. In Norway the distribution and prevalence of TBE virus (TBEV) in tick populations …


Big Data And The Future, Sherri Rose Jul 2012

Big Data And The Future, Sherri Rose

Sherri Rose

No abstract provided.


Function-On-Scalar Regression With The Refund Package, Philip T. Reiss Jul 2012

Function-On-Scalar Regression With The Refund Package, Philip T. Reiss

Philip T. Reiss

No abstract provided.


A Strain Of Piscine Myocarditis Virus (Pmcv) Infecting Argentina Silus (Ascanius), Torstein Tengs Dr. Jul 2012

A Strain Of Piscine Myocarditis Virus (Pmcv) Infecting Argentina Silus (Ascanius), Torstein Tengs Dr.

Dr. Torstein Tengs

No abstract.


Targeted Maximum Likelihood Estimation For Dynamic Treatment Regimes In Sequential Randomized Controlled Trials, Paul Chaffee, Mark J. Van Der Laan Jun 2012

Targeted Maximum Likelihood Estimation For Dynamic Treatment Regimes In Sequential Randomized Controlled Trials, Paul Chaffee, Mark J. Van Der Laan

Paul H. Chaffee

Sequential Randomized Controlled Trials (SRCTs) are rapidly becoming essential tools in the search for optimized treatment regimes in ongoing treatment settings. Analyzing data for multiple time-point treatments with a view toward optimal treatment regimes is of interest in many types of afflictions: HIV infection, Attention Deficit Hyperactivity Disorder in children, leukemia, prostate cancer, renal failure, and many others. Methods for analyzing data from SRCTs exist but they are either inefficient or suffer from the drawbacks of estimating equation methodology. We describe an estimation procedure, targeted maximum likelihood estimation (TMLE), which has been fully developed and implemented in point treatment settings, …


Comparing Years Of Healthy Life, Measured In 16 Ways, For Normal Weight And Overweight Older Adults, Paula Diehr Jun 2012

Comparing Years Of Healthy Life, Measured In 16 Ways, For Normal Weight And Overweight Older Adults, Paula Diehr

Paula Diehr

Introduction. The traditional definitions of overweight and obesity are not age specific, even though the relationship of weight to mortality is different for older adults. Effects of adiposity on aspects of health beside mortality have not been well investigated. Methods. We calculated the number of years of healthy life (YHL) in the 10 years after baseline, for 5,747 older adults. YHL was defined in 16 different ways. We compared Normal and Overweight persons, classified either by bodymass index (BMI) or by waist circumference (WC). Findings. YHL for Normal and Overweight persons differed significantly in 25% of the comparisons, of which …


Estimating The Impact Of Community-Level Interventions: The Search Trial And Hiv Prevention In Sub-Saharan Africa, Laura Balzer, Maya Petersen, Joshua Schwab, Mark Van Der Laan May 2012

Estimating The Impact Of Community-Level Interventions: The Search Trial And Hiv Prevention In Sub-Saharan Africa, Laura Balzer, Maya Petersen, Joshua Schwab, Mark Van Der Laan

Laura B. Balzer

Evaluation of community level interventions to prevent HIV infection presents significant methodological challenges. Even when it is feasible to randomly assign a treatment versus control level of the intervention to each community in a sample, measurement of incident HIV infection remains difficult. In this talk we describe an experimental design developed for the SEARCH Trial, a large community randomized trial that will evaluate the impact of expanded treatment on incident HIV and other outcomes. Regular community-wide testing campaigns are conducted and a random sample of community members who fail to attend a campaign are tracked. The data generated by this …


Why Match In Individually And Cluster Randomized Trials?, Laura B. Balzer, Maya L. Petersen, Mark J. Van Der Laan May 2012

Why Match In Individually And Cluster Randomized Trials?, Laura B. Balzer, Maya L. Petersen, Mark J. Van Der Laan

Laura B. Balzer

The decision to match individuals or clusters in randomized trials is motivated by both practical and statistical concerns. Matching protects against chance imbalances in baseline covariate distributions and is thought to improve study credibility. Matching is also implemented to increase study power. This article compares the asymptotic efficiency of the pair-matched design, where units are matched on baseline covariates and the treatment randomized within pairs, to the independent design, where units are randomly paired and the treatment randomized within pairs. We focus on estimating the average treatment effect and use the efficient influence curve to understand the information provided by …


Quantification Of Piscine Reovirus (Prv) At Different Stages Of Atlantic Salmon Salmo Salar Production, Torstein Tengs Dr. May 2012

Quantification Of Piscine Reovirus (Prv) At Different Stages Of Atlantic Salmon Salmo Salar Production, Torstein Tengs Dr.

Dr. Torstein Tengs

The newly described piscine reovirus (PRV) appears to be associated with the development of heart and skeletal muscle inflammation (HSMI) in farmed Atlantic salmon Salmo salar L. PRV seems to be ubiquitous among fish in Norwegian salmon farms, but high viral loads and tissue distribution support a causal relationship between virus and disease. In order to improve understanding of the distribution of PRV in the salmon production line, we quantified PRV by using real-time PCR on heart samples collected at different points in the life cycle from pre-smolts to fish ready for slaughter. PRV positive pre-smolts were found in about …


Why Match In Individually And Cluster Randomized Trials?, Laura Balzer, Maya Petersen, Mark Van Der Laan Apr 2012

Why Match In Individually And Cluster Randomized Trials?, Laura Balzer, Maya Petersen, Mark Van Der Laan

Laura B. Balzer

The decision to match individuals or clusters in randomized trials is motivated by both practical and statistical concerns. Matching protects against chance imbalances in baseline covariate distributions and is thereby thought to improve study credibility. Matching is also implemented to increase study power. Analogue to Rose and van der Laan (2009), this article investigates the asymptotic efficiency of pair-matching individuals or clusters relative to not matching in randomized trials. We focus on estimating the average treatment effect. We use the efficient influence curve to understand the information provided by each design for estimation of the target causal parameter. Our approach …


Smoothness Selection For Penalized Quantile Regression Splines, Philip T. Reiss, Lei Huang Apr 2012

Smoothness Selection For Penalized Quantile Regression Splines, Philip T. Reiss, Lei Huang

Philip T. Reiss

Modern data-rich analyses may call for fitting a large number of nonparametric quantile regressions. For example, growth charts may be constructed for each of a collection of variables, to identify those for which individuals with a disorder tend to fall in the tails of their age-specific distribution; such variables might serve as developmental biomarkers. When such analyses are carried out by penalized spline smoothing, reliable automatic selection of the smoothing parameter is particularly important. We show that two popular methods for smoothness selection may tend to overfit when estimating extreme quantiles as a smooth function of a predictor such as …


Semiparametric Methods For Mapping Brain Development, Philip T. Reiss, Yin-Hsiu Chen, Lan Huo Apr 2012

Semiparametric Methods For Mapping Brain Development, Philip T. Reiss, Yin-Hsiu Chen, Lan Huo

Philip T. Reiss

No abstract provided.


An Annotated Bibliography Of Methods For Analyzing Correlated Categorical Data, Mark Ashby, John Neuhaus, Walter Hauck, Peter Bacchetti, David Heilbron, Nicholas Jewell, Mark Segal, Robert Fusaro Apr 2012

An Annotated Bibliography Of Methods For Analyzing Correlated Categorical Data, Mark Ashby, John Neuhaus, Walter Hauck, Peter Bacchetti, David Heilbron, Nicholas Jewell, Mark Segal, Robert Fusaro

Mark R Segal

This paper provides an annotated bibliography of over 100 articles concerning methods for analyzing correlated categorical response data. Most of the papers listed here concern categorical regression models and estimation, with particular emphasis on binary responses. The papers are classified by several characteristics which group them according to common themes. The bibliography serves as a reference of methods for analysts of correlated categorical data, as well as for persons interested in methodologic work in this active area of statistical research.


Simple, Defensible Sample Sizes Based On Cost Efficiency -- With Discussion And Rejoinder, Peter Bacchetti, Charles E. Mcculloch, Mark R. Segal, Richard Simon, Peter Muller, Gary L. Rosner, James A. Hanley, Stan Shapiro Apr 2012

Simple, Defensible Sample Sizes Based On Cost Efficiency -- With Discussion And Rejoinder, Peter Bacchetti, Charles E. Mcculloch, Mark R. Segal, Richard Simon, Peter Muller, Gary L. Rosner, James A. Hanley, Stan Shapiro

Mark R Segal

The conventional approach of choosing sample size to provide 80% or greater power ignores the cost implications of different sample size choices. Costs, however, are often impossible for investigators and funders to ignore in actual practice. Here, we propose and justify a new approach for choosing sample size based on cost efficiency, the ratio of a study’s projected scientific and/or practical value to its total cost. By showing that a study’s projected value exhibits diminishing marginal returns as a function of increasing sample size for a wide variety of definitions of study value, we are able to develop two simple …


Joint Generalized Models For Multi-Dimensional Outcomes: A Case Study Of Neuroscience Data From Multi-Modalities, Xiao-Feng Wang Apr 2012

Joint Generalized Models For Multi-Dimensional Outcomes: A Case Study Of Neuroscience Data From Multi-Modalities, Xiao-Feng Wang

Xiaofeng Wang

This paper is motivated from the analysis of neuroscience data in a study of neural and muscular mechanisms of muscle fatigue. Multidimensional outcomes of different natures were obtained simultaneously from multiple modalities, including handgrip force, electromyography (EMG), and functional magnetic resonance imaging (fMRI). We first study individual modeling of the univariate response depending on its nature. A mixed-effects beta model and a mixed-effects simplex model are compared for modeling the force/EMG percentages. A mixed-effects negative-binomial model is proposed for modeling the fMRI counts. Then, I present a joint modeling approach to model the multidimensional outcomes together, which allows us to …


Characterization Of Gene–Environment Interactions For Colorectal Cancer Susceptibility Loci Apr 2012

Characterization Of Gene–Environment Interactions For Colorectal Cancer Susceptibility Loci

Shuo Jiao

Genome-wide association studies (GWAS) have identified more than a dozen loci associated with colorectal cancer (CRC) risk. Here, we examined potential effect-modification between single-nucleotide polymorphisms (SNP) at 10 of these loci and probable or established environmental risk factors for CRC in 7,016 CRC cases and 9,723 controls from nine cohort and case–control studies. We used meta-analysis of an efficient empirical-Bayes estimator to detect potential multiplicative interactions between each of the SNPs [rs16892766 at 8q23.3 (EIF3H/UTP23), rs6983267 at 8q24 (MYC), rs10795668 at 10p14 (FLJ3802842), rs3802842 at 11q23 (LOC120376), rs4444235 at 14q22.2 (BMP4), rs4779584 at 15q13 (GREM1), rs9929218 at 16q22.1 (CDH1), rs4939827 …


Powerful Cocktail Methods For Detecting Genome-Wide Gene-Environment Interaction, Li Hsu, Shuo Jiao, James Y. Dai, Carolyn M. Hutter, Ulrike Peters, Charles Kooperberg Apr 2012

Powerful Cocktail Methods For Detecting Genome-Wide Gene-Environment Interaction, Li Hsu, Shuo Jiao, James Y. Dai, Carolyn M. Hutter, Ulrike Peters, Charles Kooperberg

Shuo Jiao

Identifying gene and environment interaction (G × E) can provide insights into biological networks of complex diseases, identify novel genes that act synergistically with environmental factors, and inform risk prediction. However, despite the fact that hundreds of novel disease-associated loci have been identified from genome-wide association studies (GWAS), few G×Es have been discovered. One reason is thatmost studies are underpowered for detecting these interactions. Several new methods have been proposed to improve power for G × E analysis, but performance varies with scenario. In this article, we present a module-based approach to integrating various methods that exploits each method’s most …


The Effects Of Error Magnitude And Bandwidth Selection For Deconvolution With Unknown Error Distribution, Xiao-Feng Wang, Deping Ye Mar 2012

The Effects Of Error Magnitude And Bandwidth Selection For Deconvolution With Unknown Error Distribution, Xiao-Feng Wang, Deping Ye

Xiaofeng Wang

The error distribution is generally unknown in deconvolution problems with real applications. A separate independent experiment is thus often conducted to collect the additional noise data in those studies. In this paper, we study the nonparametric deconvolution estimation from a contaminated sample coupled with an additional noise sample. A ridge-based kernel deconvolution estimator is proposed and its asymptotic properties are investigated depending on the error magnitude. We then present a data-driven bandwidth selection algorithm with combining the bootstrap method and the idea of simulation extrapolation. The finite sample performance of the proposed methods and the effects of error magnitude are …


Racial And Ethnic Differences In Hospice Use Among Patients With Heart Failure, Jane Givens, Jennifer Tjia, Chao Zhou, Ezekiel Emanuel, Arlene Ash Feb 2012

Racial And Ethnic Differences In Hospice Use Among Patients With Heart Failure, Jane Givens, Jennifer Tjia, Chao Zhou, Ezekiel Emanuel, Arlene Ash

Jennifer Tjia

BACKGROUND: Heart failure is the leading noncancer diagnosis for patients in hospice care and the leading cause of hospitalization among Medicare beneficiaries. Racial and ethnic differences in hospice patients are well documented for patients with cancer but poorly described for those with heart failure.

METHODS: On the basis of a national sample of 98 258 Medicare beneficiaries 66 years and older on January 1, 2001, with a diagnosis of heart failure who had at least 1 physician or hospital encounter and who were not enrolled in hospice care between January 1 and December 31, 2000, we determined the effect of …


Disparities In Combination Drug Therapy Use In Older Adults With Coronary Heart Disease: A Cross-Sectional Time-Series In A Nationally Representative Us Sample, Jennifer Tjia, Becky Briesacher, Dawei Xie, Jason Fu, Robert Goldberg Feb 2012

Disparities In Combination Drug Therapy Use In Older Adults With Coronary Heart Disease: A Cross-Sectional Time-Series In A Nationally Representative Us Sample, Jennifer Tjia, Becky Briesacher, Dawei Xie, Jason Fu, Robert Goldberg

Jennifer Tjia

BACKGROUND: Despite evidence of effective combination drug therapy for secondary prevention of coronary heart disease (CHD), older adults with this condition remain undertreated.

OBJECTIVE: To describe time trends (1992-2003) in the adoption of combination cardiac drug therapies (beta-blockers [beta-adrenoceptor antagonists], ACE inhibitors or angiotensin II type 1 receptor antagonists [angiotensin receptor blockers; ARBs], and lipid-lowering agents) among older adults in the US with CHD and to identify factors associated with not using combination therapy.

METHODS: The study took the form of a cross-sectional time-series. The study population consisted of a nationally representative sample of adults aged >or=65 years with CHD …


Sample Size Calculations For Roc Studies: Parametric Robustness And Bayesian Nonparametrics, Dunlei Cheng, Adam J. Branscum, Wesley O. Johnson Jan 2012

Sample Size Calculations For Roc Studies: Parametric Robustness And Bayesian Nonparametrics, Dunlei Cheng, Adam J. Branscum, Wesley O. Johnson

Dunlei Cheng

Methods for sample size calculations in ROC studies often assume independent normal distributions for test scores among the diseased and non-diseased populations. We consider sample size requirements under the default two-group normal model when the data distribution for the diseased population is either skewed or multimodal. For these two common scenarios we investigate the potential for robustness of calculated sample sizes under the mis-specified normal model and we compare to sample sizes calculated under a more flexible nonparametric Dirichlet process mixture model. We also highlight the utility of flexible models for ROC data analysis and their importance to study design. …


Trends And Outcomes Associated With Angiotensin-Converting Enzyme Inhibitors, Chyke Doubeni, Carol Bigelow, Darleen Lessard, Frederick Spencer, Jorge Yarzebski, Joel Gore, Jerry Gurwitz, Robert Goldberg Jan 2012

Trends And Outcomes Associated With Angiotensin-Converting Enzyme Inhibitors, Chyke Doubeni, Carol Bigelow, Darleen Lessard, Frederick Spencer, Jorge Yarzebski, Joel Gore, Jerry Gurwitz, Robert Goldberg

Chyke A. Doubeni

BACKGROUND: Limited recent data are available describing the patterns of use of angiotensin converting enzyme inhibitor (ACEI) therapy in patients with acute myocardial infarction (AMI), particularly from the more generalizable population-based setting. The purpose of this study was to examine trends in the receipt of ACEIs and associated short-term outcomes in patients hospitalized with AMI in a large Northeastern community.

METHODS: We conducted a community-wide study of 7991 patients hospitalized with AMI in all metropolitan Worcester, Massachusetts, medical centers during 8 annual periods between 1990 and 2003.

RESULTS: Among all patients, 44% received ACEI therapy during their acute hospitalization. There …


Treatment Practices And Outcomes Of Patients With Established Peripheral Arterial Disease Hospitalized With Acute Myocardial Infarction In A Community Setting, Frederick Spencer, Darleen Lessard, Chyke Doubeni, Jorge Yarzebski, Joel Gore, Robert Goldberg Jan 2012

Treatment Practices And Outcomes Of Patients With Established Peripheral Arterial Disease Hospitalized With Acute Myocardial Infarction In A Community Setting, Frederick Spencer, Darleen Lessard, Chyke Doubeni, Jorge Yarzebski, Joel Gore, Robert Goldberg

Chyke A. Doubeni

BACKGROUND: There are little contemporary data available describing the hospital and long-term outcomes of patients with peripheral arterial disease (PAD) who are hospitalized with acute myocardial infarction (AMI). The objectives of our population-based study were to examine the hospital and long-term outcomes, as well as the use of different treatment practices, among patients with established PAD who were hospitalized with AMI. METHODS: The study sample consisted of 4480 patients hospitalized with AMI at all Worcester, Mass, medical centers in 4 alternate years between 1997 and 2003. RESULTS: Among the metropolitan Worcester residents hospitalized with AMI, 13.5% had a history of …