Science.gov

Sample records for disease utilizing satellite

  1. Predicting and Mitigating Outbreaks of Vector-Borne Disease Utilizing Satellite Remote Sensing Technology and Models

    NASA Technical Reports Server (NTRS)

    Estes, Sue; Haynes, John; Kiang, Richard; Brown, Molly; Reisen, William

    2008-01-01

    Satellite earth observations present a unique vantage point of the earth's environment from space which offers a wealth of health applications for the imaginative investigator. The session will present research results of the remote sensing environmental observations of earth and health applications. This session will an overview of many of the NASA public health applications using Remote Sensing Data and will also discuss opportunities to become a research collaborator with NASA.

  2. Predicting and Mitigating Outbreaks of Vector-Borne Disease Utilizing Satellite Remote Sensing Technology and Models

    NASA Technical Reports Server (NTRS)

    Estes, Sue; Haynes, John; Kiang, Richard; Brown, Molly; Reisen, William

    2008-01-01

    Satellite earth observations present a unique vantage point of the earth's environment from space which offers a wealth of health applications for the imaginative investigator. The session will present research results of the remote sensing environmental observations of earth and health applications. This session will an overview of many of the NASA public health applications using Remote Sensing Data and will also discuss opportunities to become a research collaborator with NASA.

  3. Predicting and Mitigating Outbreaks of Vector-Borne Disease Utilizing Satellite Remote Sensing Technology and Models

    NASA Technical Reports Server (NTRS)

    Estes, Sue M.

    2009-01-01

    The Public Health application area focuses on Earth science applications to public health and safety, particularly regarding infectious disease, emergency preparedness and response, and environmental health issues. The application explores issues of toxic and pathogenic exposure, as well as natural and man-made hazards and their effects, for risk characterization/mitigation and improvements to health and safety. The program elements of the NASA Applied Sciences Program are: Agricultural Efficiency, Air Quality, Climate, Disaster Management, Ecological Forecasting, Water Resources, Weather, and Public Health.

  4. Uses of communication satellites in water utility operations

    NASA Astrophysics Data System (ADS)

    Tighe, W. S.

    This paper proposes a system to serve the communications needs of the operating side of a water utility and estimates the requirements and capabilities of the equipment needed. The system requires the shared use of a satellite transponder with 100% backup. Messages consist of data packets containing data and control information, plus voice transmission. Satellite communication may have a price advantage in some instances over wire line or VHF radio and have greater survivability in case of a natural disaster. Water and other utilities represent a significant market for low cost mass produced satellite earth terminals.

  5. Satellite utilization for educational communications in the U.S.

    NASA Technical Reports Server (NTRS)

    Morgan, R. P.; Singh, J. P.

    1974-01-01

    This paper summarizes completed, continuing and planned satellite experiments in the U.S. related to the delivery of educational services and networking. It also describes some results of an on-going study at Washington University directed towards defining applications of fixed/broadcast communication satellites in the U.S. and alternative systems and strategies for large-scale telecommunication-based educational delivery systems utilizing satellites. An analysis is presented of recent actions which may influence future development of such systems.

  6. Planning satellite communication services and spectrum-orbit utilization

    NASA Technical Reports Server (NTRS)

    Sawitz, P. H.

    1982-01-01

    The relationship between approaches to planning satellite communication services and spectrum-orbit utilization is considered, with emphasis on the fixed-satellite and the broadcasting-satellite services. It is noted that there are several possible approaches to planning space services, differing principally in the rigidity with which technical parameters are prescribed, in the time for which a plan remains in force, and in the procedures adopted for implementation and modifications. With some planning approaches, spectrum-orbit utilization is fixed at the time the plan is made. Others provide for greater flexibility by making it possible to postpone some decisions on technical parameters. In addition, the two political questions of what is equitable access and how it can be guaranteed in practice play an important role.

  7. Utilizing expert systems for satellite monitoring and control

    NASA Technical Reports Server (NTRS)

    Hughes, Peter M.

    1991-01-01

    Spacecraft analysts in the spacecraft control center for the Cosmic Background Explorer (COBE) satellite are currently utilizing a fault-isolation expert system developed to assist in the isolation and correction of faults in the communications link. This system, the communication link expert assistance resource (CLEAR), monitors real time spacecraft and ground systems performance parameters in search of configuration discrepancies and communications link problems. If such a discrepancy or problem is isolated, CLEAR alerts the analyst and provides advice on how to resolve the problem swiftly and effectively. The CLEAR system is the first real time expert system to be used in the operational environment of a satellite control center at the NASA Goddard Space Flight Center. Clear has not only demonstrated the utility and potential of an expert system in the demanding environment of a satellite control center, but also has revealed many of the pitfalls and deficiencies of development of expert systems. One of the lessons learned from this and other initial expert system projects is that prototypes can often be developed quite rapidly, but operational expert systems require considerable effort. Development is generally a slow, tedious process that typically requires the special skills of trained programmers. Due to the success of CLEAR and several other systems in the control center domain, a large number of expert systems will certainly be developed to support control center operations during the early 1990's. To facilitate the development of these systems, a project was initiated to develop an integrated, domain-specific tool, the generic spacecraft analyst assistent (GenSAA), that alows the spacecraft analysts to rapidly create simple expert systems themselves. By providing a highly graphical point-and-select method of system development, GenSAA allows the analyst to utilize and/or modify previously developed rule bases and system components; thus, facilitating

  8. Spectrum-orbit utilization - An overview. [domestic satellite communication systems

    NASA Technical Reports Server (NTRS)

    Sawitz, P. H.

    1975-01-01

    This paper discusses the problems associated with the efficient utilization of the natural resources of frequency spectrum and geo-stationary orbital arc. The nature of these resources is explained and their quantities are estimated. The present and projected future demand for them is given, and the problem areas are identified and discussed. Special emphasis is placed on mutual interference, launch limitations, propagation effects, and operational restrictions. The technical factors bearing on these problems, such as antenna patterns, modulation methods, emission restrictions, equipment characteristics, and system requirements, are discussed in detail. Some important trade-offs are presented, and special techniques that can be used to increase spectrum-orbit utilization are described. Particular emphasis is given throughout to U.S. domestic satellite communication systems.

  9. Eulusmap: An international land resources map utilizing satellite imagery

    NASA Technical Reports Server (NTRS)

    Paludan, T.; Csati, E.

    1978-01-01

    In 1972, the International Geographical Union's Commission on World Land Use Survey adopted a project for a land-use map of Europe. Such a map, under the name Eulusmap was started earlier under sponsorship of several government offices in Hungary. Although there was great response from a number of contributors in many countries, it became evident by mid-1974 that the map would contain gaps and some inaccuracies unless additional data sources were utilized. By then, the satellite Landsat-1 had obtained imagery of most of Europe. Using theme extraction techniques, the map was completed in draft form and portions of it displayed at the 23d International Geographical Congress in Moscow during July 1976. Printing of the completed map was accomplished in May 1978.

  10. Utilizing Satellite-derived Precipitation Products in Hydrometeorological Applications

    NASA Astrophysics Data System (ADS)

    Liu, Z.; Ostrenga, D.; Teng, W. L.; Kempler, S. J.; Huffman, G. J.

    2012-12-01

    Each year droughts and floods happen around the world and can cause severe property damages and human casualties. Accurate measurement and forecast are important for preparedness and mitigation efforts. Through multi-satellite blended techniques, significant progress has been made over the past decade in satellite-based precipitation product development, such as, products' spatial and temporal resolutions as well as timely availability. These new products are widely used in various research and applications. In particular, the TRMM Multi-satellite Precipitation Analysis (TMPA) products archived and distributed by the NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC) provide 3-hourly, daily and monthly near-global (50° N - 50° S) precipitation datasets for research and applications. Two versions of TMPA products are available, research (3B42, 3B43, rain gauge adjusted) and near-real-time (3B42RT). At GES DISC, we have developed precipitation data services to support hydrometeorological applications in order to maximize the TRMM mission's societal benefits. In this presentation, we will present examples of utilizing TMPA precipitation products in hydrometeorological applications including: 1) monitoring global floods and droughts; 2) providing data services to support the USDA Crop Explorer; 3) support hurricane monitoring activities and research; and 4) retrospective analog year analyses to improve USDA's world agricultural supply and demand estimates. We will also present precipitation data services that can be used to support hydrometeorological applications including: 1) User friendly TRMM Online Visualization and Analysis System (TOVAS; URL: http://disc2.nascom.nasa.gov/Giovanni/tovas/); 2) Mirador (http://mirador.gsfc.nasa.gov/), a simplified interface for searching, browsing, and ordering Earth science data at GES DISC; 3) Simple Subset Wizard (http://disc.sci.gsfc.nasa.gov/SSW/ ) for data subsetting and format conversion; 4) Data

  11. Spectrum/orbit utilization program for geostationary satellites

    NASA Technical Reports Server (NTRS)

    Miller, E. F.

    1984-01-01

    Mutual interferences among geostationary satellite communication systems determine the permitted spacing between satellites and the limits on the capacity of the orbit/spectrum resources available. This paper describes the computer program for analyzing the mutual interferences among communication satellite systems. Capabilities of the program are described. Inputs, models used, program operations, and program outputs are given. To show application of the program, an example scenario is analyzed for fixed satellites providing domestic service to North America.

  12. An initial approach to the utilization of VAS satellite sounding data

    NASA Technical Reports Server (NTRS)

    Shin, Kyung-Sup; Scoggins, James R.

    1984-01-01

    The primary objective is the development of methods to utilize satellite soundings. To achieve that, a more precise understanding of the characteristics of satellite derived soundings is required. The initial approach in the utilization of satellite soundings is to find a way to combine rawinsondes and satellite data into a unified data set. If this can be done in a meaningful way, satellite data could be integrated into existing data and interpretation would be enhanced. In this attempt, both rawinsonde and satellite soundings will be decomposed by the use of the Fourier cosine series. Then, each harmonic will be compared to get a better understanding of the representativeness of the satellite sounding data. Harmonics taken from satellite and rawinsonde soundings will be combined to provide a unified data set that can be used both over data sparse ocean areas as well as over land where rawinsonde data are available.

  13. Utilization of NASA Lewis mobile terminals for the Hermes satellite

    NASA Technical Reports Server (NTRS)

    Edelman, E. A.; Fiala, J. L.; Rizzolla, L.

    1977-01-01

    The paper describes the portable earth terminal (PET) and the transportable earth terminal (TET) which enable two-way television and voice communication. Both terminals were developed by NASA and utilize the high power of the Hermes satellite. PET is a bus-type vehicle which has receiving equipment for full duplex color television and which can transmit programs originating in either the on-board PET studio or in nearby buildings. PET has a collapsible 2.4-m diameter parabolic antenna interfacing with a 500-watt 14-GHz wideband TV transmitter and a 12-GHz wideband TV receiver system. TET uses two parabolic reflector antennas, 3 m and 1.2 m in diameter, mounted on a flat trailer towed by a truck. TET can receive and relay color TV signals, and its narrowband transmitter can serve as a return audio link permitting a question-and-answer format. Also described are uplink and downlink performance characteristics, operation procedures, and field demonstrations which enabled personnel at several hospitals to participate in a distant medical conference.

  14. Utilization of NASA Lewis mobile terminals for the Hermes satellite

    NASA Technical Reports Server (NTRS)

    Edelman, E. A.; Fiala, J. L.; Rizzolla, L.

    1977-01-01

    The paper describes the portable earth terminal (PET) and the transportable earth terminal (TET) which enable two-way television and voice communication. Both terminals were developed by NASA and utilize the high power of the Hermes satellite. PET is a bus-type vehicle which has receiving equipment for full duplex color television and which can transmit programs originating in either the on-board PET studio or in nearby buildings. PET has a collapsible 2.4-m diameter parabolic antenna interfacing with a 500-watt 14-GHz wideband TV transmitter and a 12-GHz wideband TV receiver system. TET uses two parabolic reflector antennas, 3 m and 1.2 m in diameter, mounted on a flat trailer towed by a truck. TET can receive and relay color TV signals, and its narrowband transmitter can serve as a return audio link permitting a question-and-answer format. Also described are uplink and downlink performance characteristics, operation procedures, and field demonstrations which enabled personnel at several hospitals to participate in a distant medical conference.

  15. Geostationary communications satellite orbit utilization strategies for the 1980s

    NASA Astrophysics Data System (ADS)

    Hedinger, R. A.

    Orbital congestion became apparent when the number of applications filed with the Federal Communication Commission (FCC) for 6/4 GHz orbital slots exceeded the number of slots available. In order to overcome this congestion, approaches must be studied for increasing the capacity of the geostationary orbit. In connection with an identification of the factors which affect geostationary orbit capacity, three types of capacity are introduced, including site capacity, service area capacity, and total capacity of the geostationary orbit. Attention is given to approaches for increasing the number of satellites in the geostationary orbit, the phased introduction of new technology, increased interference allocations from other satellites, methods for increasing the spectral efficiency by channel equipment design, the possibility to increase the spectral efficiency by antenna design and frequency reuse, procedures for increasing the available bandwidth, and the development of techniques for optimizing the placement of satellites serving different service areas.

  16. Multipath study for a low altitude satellite utilizing a data relay satellite system

    NASA Technical Reports Server (NTRS)

    Eggert, D.

    1970-01-01

    Technical considerations associated with a low altitude satellite operating in conjuction with a data relay satellite system are reported. Emphasis was placed on the quantitative characterization of multipath phenomenon and determination of power received via both the direct and earth reflection paths. Attempts were made to develop a means for estimating the magnitude and nature of the reflected power.

  17. Proposed advanced satellite applications utilizing space nuclear power systems

    NASA Technical Reports Server (NTRS)

    Bailey, Patrick G.; Isenberg, Lon

    1990-01-01

    A review of the status of space nuclear reactor systems and their possible applications is presented. Such systems have been developed over the past twenty years and are capable of use in various military and civilian applications in the 5-1000-kWe power range. The capabilities and limitations of the currently proposed nuclear reactor systems are summarized. Statements of need are presented from DoD, DOE, and NASA. Safety issues are identified, and if they are properly addressed they should not pose a hindrance. Applications are summarized for the DoD, DOE, NASA, and the civilian community. These applications include both low- and high-altitude satellite surveillance missions, communications satellites, planetary probes, low- and high-power lunar and planetary base power systems, broadband global telecommunications, air traffic control, and high-definition television.

  18. Proposed advanced satellite applications utilizing space nuclear power systems

    NASA Technical Reports Server (NTRS)

    Bailey, Patrick G.; Isenberg, Lon

    1990-01-01

    A review of the status of space nuclear reactor systems and their possible applications is presented. Such systems have been developed over the past twenty years and are capable of use in various military and civilian applications in the 5-1000-kWe power range. The capabilities and limitations of the currently proposed nuclear reactor systems are summarized. Statements of need are presented from DoD, DOE, and NASA. Safety issues are identified, and if they are properly addressed they should not pose a hindrance. Applications are summarized for the DoD, DOE, NASA, and the civilian community. These applications include both low- and high-altitude satellite surveillance missions, communications satellites, planetary probes, low- and high-power lunar and planetary base power systems, broadband global telecommunications, air traffic control, and high-definition television.

  19. Passive Micro Vibration Isolator Utilizing Flux Pinning Effect for Satellites

    NASA Astrophysics Data System (ADS)

    Shibata, Takuma; Sakai, Shin-ichiro

    2016-09-01

    Information related to the origin of space and evolution of galaxy can be obtained using the observation satellites. In recent years, high pointing accuracy is demanded for getting more detailed data about distant stars and galaxies. As a result, vibration isolators that consist of a main structure and a TTM (Tip Tilt Mirror) have been adopted for observation satellites. However, cutting the low frequency vibrations off passively with the conventional methods is difficult. A vibration isolator that uses pinning effect is proposed for solving this problem. The pinning effect is acquired by cooling the type-II superconductor below the critical temperature and it generates a pinning force to maintain the relative distance and attitude between a type- II superconductor and a material that generates magnetic flux. The mission part and the bus part of the satellite are equipped with superconductors and permanent magnets and these parts perform short distance formation flight by applying the effect. This method can cut vibrations from low to high frequency bands off passively. In addition, Meissner effect can prevent collision of the mission and bus parts. In order to investigate the performance of this system, experiments and simulations are carried out and the results are discussed.

  20. Utilizing a TDRS satellite for direct broadcast satellite-radio propagation experiments and demonstrations

    NASA Technical Reports Server (NTRS)

    Hollansworth, James E.

    1993-01-01

    The NASA/VOA Direct Broadcast Satellite-Radio (DBS-R) Program will be using a NASA Tracking Data Relay Satellite (TDRS) satellite at 62 deg. West longitude to conduct live satellite S-band propagation experiments and demonstrations of satellite sound broadcasting over the next two years (1993-1994). The NASA/VOA DBS-R program has applied intensive effort to garner domestic and international support for the DBS-R concept. An S-band DBS-R allocation was achieved for Region 2 at WARC-92 held in Spain. With this allocation, the DBS-R program now needs to conduct S-band propagation experiments and systems demonstrations that will assist in the development of planning approaches for the use of Broadcast Satellite Service (Sound) frequency bands prior to the planning conference called for by WARC-92. These activities will also support receiver concept development applied to qualities ranging from AM to Monophonic FM, Stereophonic FM, Monophonic CD, and Stereophonic CD quality.

  1. Utilizing a TDRS satellite for direct broadcast satellite-radio propagation experiments and demonstrations

    NASA Technical Reports Server (NTRS)

    Hollansworth, James E.

    1993-01-01

    The NASA/VOA Direct Broadcast Satellite - Radio (DBS-R) Program will be using a NASA Tracking Data Relay Satellite (TDRS) satellite at 62 deg West longitude to conduct live satellite S-band propagation experiments and demonstrations of satellite sound broadcasting over the next two years (1993-1994). The NASA/VOA DBS-R program has applied intensive effort to garner domestic and international support for the DBS-R concept. An S-band DBS-R allocation was achieved for Region 2 at WARC-92 held in Spain. With this allocation, the DBS-R program now needs to conduct S-band propagation experiments and systems demonstrations that will assist in the development of planning approaches for the use of Broadcast Satellite Service (Sound) frequency bands prior to the planning conference called for by WARC-92. These activities will also support receiver concept development applied to qualities ranging from AM to Monophonic FM, Stereophonic FM, Monophonic CD, and Stereophonic CD quality.

  2. Utilization of NASA Lewis mobile terminals for the Hermes satellite

    NASA Technical Reports Server (NTRS)

    Edelman, E. A.; Fiala, J. L.; Rizzolla, L.

    1977-01-01

    The high power of the Hermes satellite enables two-way television and voice communication with small ground terminals. The Portable Earth Terminal (PET) and the Transportable Earth Terminal (TET) were developed and built by NASA-Lewis to provide communications capability to short-term users. The NASA-Lewis mobile terminals are described in terms of vehicles and onboard equipment, as well as operation aspects, including use in the field. The section on demonstrations divides the uses into categories of medicine, education, technology and government. Applications of special interest within each category are briefly described.

  3. Utilizing a TDRS satellite for direct broadcast satellite-radio propagation experiments and demonstrations

    NASA Technical Reports Server (NTRS)

    Hollansworth, James E.

    1993-01-01

    The NASA/VOA Direct Broadcast Satellite - Radio (DBS-R) Program will be using a NASA Tracking Data Relay Satellite (TDRS) at 62 deg West longitude to conduct live satellite S-band propagation experiments and demonstrations of satellite sound broadcasting over the next two years (1993-1994). The NASA/VOA DBS-R program has applied intensive effort to garner domestic and international support for the DBS-R concept. An S-band DBS-R allocation was achieved for Region 2 at WARC-92 held in Spain. With this allocation, the DBS-R program now needs to conduct S-band propagation experiments and systems demonstrations that will assist in the development of planning approaches for the use of Broadcast Satellite Service (Sound) frequency bands prior to the planning conference called for by WARC-92. These activities will also support receiver concept development applied to qualities ranging from AM to Monophonic FM, Stereophonic FM, Monophonic CD, and Stereophonic CD quality.

  4. Utility of Thermal Infrared Satellite Data For Urban Landscapes

    NASA Astrophysics Data System (ADS)

    Xian, G.; Crane, M.; Granneman, B.

    2006-12-01

    Urban landscapes are comprised of a variety of surfaces that are characterized by contrasting radiative, thermal, aerodynamic, and moisture properties. These different surfaces possess diverse physical and thermal attributes that directly influence surface energy balance and our ability to determine surface characteristics in urban areas. Reflectance properties obtained from satellite imagery have proven useful for mapping urban land use and land cover change, as well as ecosystem health. Landsat reflectance bands are commonly used in regression tree models to generate linear equations that correspond to distinct land surface materials. However, urban land cover is generally a heterogeneous mix of bare soil, vegetation, rock, and anthropogenic impervious surfaces. Surface temperature obtained from satellite thermal infrared bands provides valuable information about surface biophysical properties and radiant thermal characteristics of land cover elements, especially for urban environments. This study demonstrates the improved characterization of land cover conditions for Seattle, Washington, and Las Vegas, Nevada, that were achieved by using both the reflectance and thermal bands of Landsat Enhanced Thematic Mapper Plus (ETM+) data. Including the thermal band in the image analysis increased the accuracy of discriminating cover types in heterogeneous landscapes with extreme contrasts, especially for mixed pixels at the urban interface.

  5. Saturn ring rendezvous mission utilizing a tethered sub-satellite

    NASA Technical Reports Server (NTRS)

    Bright, Larry E.

    1990-01-01

    By combining the advanced technologies of constant-thrust propulsion and space tethers in a planetary mission, it may be feasible to perform a complete radial and azimuthal survey of the Saturnian ring system from close range (about 10 km) in a period of some 300 days. Constant-thrust propulsion would provide the means of 'hovering' above the rings while simultaneously spiraling radially inward toward Saturn. Use of a tethered sub-satellite at a distance of 500-1000 km from the main spacecraft would permit an instrumented package to achieve a significant azimuthal angular rate relative to the rings. Exhaustive 360 deg azimuthal mapping at one or two selected distances from Saturn could be performed in a few tens of days.

  6. Satellite applications to electric-utility communications needs. [land mobile satellite service

    NASA Technical Reports Server (NTRS)

    Horstein, M.; Barnett, R.

    1981-01-01

    Significant changes in the Nation's electric power systems are expected to result from the integration of new technology, possible during the next decade. Digital communications for monitor and control, exclusive of protective relaying, are expected to double or triple current traffic. A nationwide estimate of 13 Mb/s traffic is projected. Of this total, 8 Mb/s is attributed to the bulk-power system as it is now being operated (4 Mb/s). This traffic could be accommodated by current communications satellites using 3- to 4.5-m-diameter ground terminals costing $35,000 to $70,000 each. The remaining 5-Mb/s traffic is attributed to new technology concepts integrated into the distribution system. Such traffic is not compatible with current satellite technology because it requires small, low-cost ground terminals. Therefore, a high effective isotropic radiated power satellite, such as the one being planned by NASA for the Land Mobile Satellite Service, is required.

  7. A 15.3 GHz satellite-to-ground diversity experiment utilizing the ATS-5 satellite

    NASA Technical Reports Server (NTRS)

    Hodge, D. B.

    1972-01-01

    During 1970 and 1971 the characteristics of a diversity satellite-to-ground communication link were measured using the ATS-5 15.3 GHz downlink. These data were gathered at two ground receiving terminals spaced 4 km apart during 1970 and 8 km apart during 1971 in the vicinity of Columbus, Ohio. These data have been subsequently analyzed to determine the improvement in link performance resulting from the use of space diversity. The results of this analysis have shown that substantial improvements in link performance may be gained through the use of space diversity on satellite-to-ground paths. For example, the durations of fades having depths exceeding 10 dB were reduced by more than two orders of magnitude for both the 4 and 8 km site separation distances.

  8. Satellite Orbit Programs Utilizing the Graphics Capabilities of the Microcomputer.

    DTIC Science & Technology

    1986-06-01

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  9. Utilization of high resolution satellite gravity over the Carlsberg Ridge

    NASA Astrophysics Data System (ADS)

    Chatterjee, S.; Bhattacharyya, R.; Majumdar, T. J.

    2007-12-01

    The Carlsberg Ridge lies between the equator and the Owen fracture zone. It is the most prominent mid-ocean ridge segment of the western Indian Ocean, which contains a number of earthquake epicenters. Satellite altimetry can be used to infer subsurface geological structures analogous to gravity anomaly maps generated through ship-borne survey. In this study, free-air gravity and its 3D image have been generated over the Carlsberg Ridge using a very high resolution data base, as obtained from Geosat GM, ERS-1, Seasat and TOPEX/POSEIDON altimeter data. As observed in this study, the Carlsberg Ridge shows a slow spreading characteristic with a deep and wide graben (average width ˜15 km). The transform fault spacing confirms variable slow to intermediate characteristics with first and second order discontinuities. The isostatically compensated region of the Carlsberg Ridge could be demarcated with near zero contour values in the free-air gravity anomaly images over and along the Carlsberg Ridge axes and over most of the fracture zone patterns. Few profiles have been generated across the Carlsberg Ridge and the characteristics of slow/intermediate spreading ridge of various orders of discontinuity could be identified. It has also been observed in zero contour image as well as in the characteristics of valley patterns along the ridge from NW to SE that different spreading rates, from slow to intermediate, are occurring in different parts of the Carlsberg ridge. It maintains the morphology of a slow spreading ridge in the NW, where the wide and deep axial valley (˜1.5 3 km) also implies the pattern of a slow spreading ridge. However, a change in the morphology/depth of the axial valley from NW to SE indicates the nature of the Carlsberg Ridge as a slow to intermediate spreading ridge.

  10. Utilization of satellite imagery by in-flight aircraft. [for weather information

    NASA Technical Reports Server (NTRS)

    Luers, J. K.

    1976-01-01

    Present and future utilization of satellite weather data by commercial aircraft while in flight was assessed. Weather information of interest to aviation that is available or will become available with future geostationary satellites includes the following: severe weather areas, jet stream location, weather observation at destination airport, fog areas, and vertical temperature profiles. Utilization of this information by in-flight aircraft is especially beneficial for flights over the oceans or over remote land areas where surface-based observations and communications are sparse and inadequate.

  11. The Impact of Ionospheric Delay on the Frequency Transfer Utilizing A LEO Satellite

    NASA Astrophysics Data System (ADS)

    Tian, Shi-Wei; Xu, Rong; Yu, Yong; Chang, Jiang; Li, Guang-Xia

    2015-04-01

    Using the frequency of assisted signals transferred by a LEO (Low Earth Orbit) satellite to extend the coherence time of inexpensive GNSS (Global Navigation Satellite System) receiver clocks is one of the most effective methods to improve the performance of the GNSS receivers that may be in hostile environments or subject to interference. Among the factors affecting the results of frequency transfer, ionospheric delay is the most important one. In this work, the principles for frequency transfer utilizing an LEO satellite and the corresponding error sources are analyzed. Especially, the impact of ionospheric delay is ana- lyzed, and a correction method utilizing the ionospheric delay difference between the neighboring epoches and that between two stations is presented. Simulations are performed to validate the above analysis and correction method. The results show that with the correction proposed in this paper, the requirements for the frequency transfer can be met.

  12. Satellites

    SciTech Connect

    Burns, J.A.; Matthews, M.S.

    1986-01-01

    The present work is based on a conference: Natural Satellites, Colloquium 77 of the IAU, held at Cornell University from July 5 to 9, 1983. Attention is given to the background and origins of satellites, protosatellite swarms, the tectonics of icy satellites, the physical characteristics of satellite surfaces, and the interactions of planetary magnetospheres with icy satellite surfaces. Other topics include the surface composition of natural satellites, the cratering of planetary satellites, the moon, Io, and Europa. Consideration is also given to Ganymede and Callisto, the satellites of Saturn, small satellites, satellites of Uranus and Neptune, and the Pluto-Charon system.

  13. On attaining lower sidelobes and new antenna envelopes for better orbit spectrum utilization in satellite broadcasting

    NASA Technical Reports Server (NTRS)

    Janky, J. M.; Zaumen, W. T.; Lee, L.-S.

    1979-01-01

    The concept of using beam-shaping techniques to reduce sidelobe levels at the expense of efficiency is introduced and analyzed with respect to the potential for improving orbit-spectrum utilization. Emphasis is placed on a simple method: improving the antenna patterns used in satellite systems, for both the satellite antennas and the ground station antennas. Only broadcasting applications are considered. The discussion includes how the antenna envelope can be improved, how this improvement can be interpreted in terms of orbit spectrum utilization efficiency, and whether this improved envelope is actually realizable and feasible. It is noted that the magnitude of the improvement with a better spacecraft antenna increases rapidly as the coverage area decreases.

  14. Effective Utilization of Satellite Observations for Assessing Transnational Impact of Disasters

    NASA Astrophysics Data System (ADS)

    Alozie, J. E.; Anuforom, A. C.

    2014-12-01

    General meteorological observations sources for the surface, upper air and outer space are conducted using different technological equipment and instruments that meet international standards prescribed and approved by the United Nations organizations such as the International Civil Aviation Organization (ICAO) and the World Meteorological Organization (WMO). Satellite weather observations are critical for effective monitoring of the developments, propagations and disseminations of cold clouds and their expected adverse weather conditions as they move across national and transnational boundaries. The Nigerian Meteorological Agency (NiMet) which is the national weather service provider for Nigeria, utilizes an array of satellite products obtained from mainly the European Meteorological Satellite (EUMETSAT) for its routine weather and climate monitoring and forecasts. Overtime, NiMet has used weather workstations such as MSG, SYNERGIE and now PUMA for accessing satellite products such as RGB, Infra-red, Water vapour and the Multi-sensor Precipitation Estimate (MPE) obtained at near real-time periods. The satellite imageries find extensive applications in the delivery of early warning of raising of severe weather conditions such as dust storm and dust haze during the harmattan season (November - February); and thunderstorm accompanied by severe lightning and destructive strong winds. The paper will showcase some special cases of the tracking of squall lines and issuance of weather alerts through the media. The good result is that there was limited damage to infrastructure and no loss of life from the flash floods caused by the heavy rainfall from the squally thunderstorm.

  15. Satellite hemodialysis services for patients with end stage renal disease.

    PubMed

    Organ, Kathy; MacDonald, Sandra

    2014-01-01

    More than 40,000 Canadians are living with end stage renal disease and approximately 22,400 of those are currently being treated with hemodialysis (The Kidney Foundation of Canada, 2013). Long distance travel to access hemodialysis services can be a serious burden for patients, and travelling more than 60 minutes can mean a 20% greater risk for death, as compared with those who travel 15 minutes or less (Moist et al., 2008). Satellite hemodialysis units are seen as one solution to this problem. This study assessed the impact of services provided by one satellite hemodialysis unit on patients' satisfaction, access to care and quality of life using a qualitative interview research design. Seven patients were interviewed and three themes emerged including the burden of long distance travel before satellite services (safety, time and cost), satisfaction with satellite services (pleasant environment and continuity of care), and improved quality of life. This study showed that a satellite hemodialysis unit improved access to services and enhanced the quality of life of those patients who participated in the study.

  16. Utilization of Precipitation and Moisture Products Derived from Satellites to Support NOAA Operational Precipitation Forecasts

    NASA Astrophysics Data System (ADS)

    Ferraro, R.; Zhao, L.; Kuligowski, R. J.; Kusselson, S.; Ma, L.; Kidder, S. Q.; Forsythe, J. M.; Jones, A. S.; Ebert, E. E.; Valenti, E.

    2012-12-01

    NOAA/NESDIS operates a constellation of polar and geostationary orbiting satellites to support weather forecasts and to monitor the climate. Additionally, NOAA utilizes satellite assets from other U.S. agencies like NASA and the Department of Defense, as well as those from other nations with similar weather and climate responsibilities (i.e., EUMETSAT and JMA). Over the past two decades, through joint efforts between U.S. and international government researchers, academic partners, and private sector corporations, a series of "value added" products have been developed to better serve the needs of weather forecasters and to exploit the full potential of precipitation and moisture products generated from these satellites. In this presentation, we will focus on two of these products - Ensemble Tropical Rainfall Potential (eTRaP) and Blended Total Precipitable Water (bTPW) - and provide examples on how they contribute to hydrometeorological forecasts. In terms of passive microwave satellite products, TPW perhaps is most widely used to support real-time forecasting applications, as it accurately depicts tropospheric water vapor and its movement. In particular, it has proven to be extremely useful in determining the location, timing, and duration of "atmospheric rivers" which contribute to and sustain flooding events. A multi-sensor approach has been developed and implemented at NESDIS in which passive microwave estimates from multiple satellites and sensors are merged to create a seamless, bTPW product that is more efficient for forecasters to use. Additionally, this product is being enhanced for utilization for television weather forecasters. Examples will be shown to illustrate the roll of atmospheric rivers and contribution to flooding events, and how the bTPW product was used to improve the forecast of these events. Heavy rains associated with land falling tropical cyclones (TC) frequently trigger floods that cause millions of dollars of damage and tremendous loss

  17. Impacts and Benefits of a Satellite Power System on the Electric Utility Industry

    NASA Technical Reports Server (NTRS)

    Winer, B. M.

    1977-01-01

    The purpose of this limited study was to investigate six specific issues associated with interfacing a Satellite Power System (5 GW) with large (by present standards) terrestrial power pools to a depth sufficient to determine if certain interface problems and/or benefits exist and what future studies of these problems are required. The issues investigated are as follows: (1) Stability of Power Pools Containing a 5 GWe SPS; (2) Extra Reserve Margin Required to Maintain the Reliability of Power Pools Containing a 5 GWe SPS; (3) Use of the SPS in Load Following Service (i.e. in two independent pools whose times of peak demand differ by three hours); (4) Ownership of the SPS and its effect on SPS Usage and Utility Costs; (5) Utility Sharing of SPS related RD and D Costs; (6) Utility Liability for SPS Related Hazards.

  18. The utilization of nonterrestrial materials. [resources for solar power satellite construction

    NASA Technical Reports Server (NTRS)

    1981-01-01

    The development of research and technology programs on the user of nonterrestrial materials for space applications was considered with emphasis on the space power satellite system as a model of large space systems for which the use of nonterrestrial materials may be economically viable. Sample topics discussed include the mining of raw materials and the conversion of raw materials into useful products. These topics were considered against a background of the comparative costs of using terrestrial materials. Exploratory activities involved in the preparation of a nonterrestrial materials utilization program, and the human factors involved were also addressed. Several recommendations from the workshop are now incorporated in NASA activities.

  19. Utilization of photovoltaic for broadband satellite communications in rural area of Thailand

    NASA Astrophysics Data System (ADS)

    Jinayim, Theerawut; Mungkung, Narong; Kasayapanand, Nat

    2013-06-01

    Electricity, Information and Communication Technologies (ICTs) are very important not only in urban areas but also in rural areas. To provide ICTs service in rural areas, sources of electricity and communication infrastructures must be implemented. Electricity is a major condition due to the fact that all electronic devices needed it in order to power on, so that it is impossible to operate any forms of ICTs in areas where the main national grid line is unavailable. Almost rural areas of Thailand where the main national grid line is unavailable have very good sunlight intensity. Photovoltaic is the most effective renewable energy technologies in those areas for meeting electricity needed in areas that are not connected to the main national grid line. In this paper, the efficiency utilization of photovoltaic as source of electricity for broadband satellite communication systems as well as social and economic impact and quality of life of people in rural areas of Thailand are presented. The results show that most rural communities would be able to universally access to the basic telecommunications services such as internet access and public telephone via satellite communication systems. However, in some field case study, broadband internet access via satellite communication may be unnecessary for some rural communities and the most exactly rural communities needed are electricity for household usage and battery charger.

  20. Examining the utility of satellite-based wind sheltering estimates for lake hydrodynamic modeling

    USGS Publications Warehouse

    Van Den Hoek, Jamon; Read, Jordan S.; Winslow, Luke A.; Montesano, Paul; Markfort, Corey D.

    2015-01-01

    Satellite-based measurements of vegetation canopy structure have been in common use for the last decade but have never been used to estimate canopy's impact on wind sheltering of individual lakes. Wind sheltering is caused by slower winds in the wake of topography and shoreline obstacles (e.g. forest canopy) and influences heat loss and the flux of wind-driven mixing energy into lakes, which control lake temperatures and indirectly structure lake ecosystem processes, including carbon cycling and thermal habitat partitioning. Lakeshore wind sheltering has often been parameterized by lake surface area but such empirical relationships are only based on forested lakeshores and overlook the contributions of local land cover and terrain to wind sheltering. This study is the first to examine the utility of satellite imagery-derived broad-scale estimates of wind sheltering across a diversity of land covers. Using 30 m spatial resolution ASTER GDEM2 elevation data, the mean sheltering height, hs, being the combination of local topographic rise and canopy height above the lake surface, is calculated within 100 m-wide buffers surrounding 76,000 lakes in the U.S. state of Wisconsin. Uncertainty of GDEM2-derived hs was compared to SRTM-, high-resolution G-LiHT lidar-, and ICESat-derived estimates of hs, respective influences of land cover type and buffer width on hsare examined; and the effect of including satellite-based hs on the accuracy of a statewide lake hydrodynamic model was discussed. Though GDEM2 hs uncertainty was comparable to or better than other satellite-based measures of hs, its higher spatial resolution and broader spatial coverage allowed more lakes to be included in modeling efforts. GDEM2 was shown to offer superior utility for estimating hs compared to other satellite-derived data, but was limited by its consistent underestimation of hs, inability to detect within-buffer hs variability, and differing accuracy across land cover types. Nonetheless

  1. Analysis on the Utility of Satellite Imagery for Detection of Agricultural Facility

    NASA Astrophysics Data System (ADS)

    Kang, J.-M.; Baek, S.-H.; Jung, K.-Y.

    2012-07-01

    Now that the agricultural facilities are being increase owing to development of technology and diversification of agriculture and the ratio of garden crops that are imported a lot and the crops cultivated in facilities are raised in Korea, the number of vinyl greenhouses is tending upward. So, it is important to grasp the distribution of vinyl greenhouses as much as that of rice fields, dry fields and orchards, but it is difficult to collect the information of wide areas economically and correctly. Remote sensing using satellite imagery is able to obtain data of wide area at the same time, quickly and cost-effectively collect, monitor and analyze information from every object on earth. In this study, in order to analyze the utilization of satellite imagery at detection of agricultural facility, image classification was performed about the agricultural facility, vinyl greenhouse using Formosat-2 satellite imagery. The training set of sea, vegetation, building, bare ground and vinyl greenhouse was set to monitor the agricultural facilities of the object area and the training set for the vinyl greenhouses that are main monitoring object was classified and set again into 3 types according the spectral characteristics. The image classification using 4 kinds of supervise classification methods applied by the same training set were carried out to grasp the image classification method which is effective for monitoring agricultural facilities. And, in order to minimize the misclassification appeared in the classification using the spectral information, the accuracy of classification was intended to be raised by adding texture information. The results of classification were analyzed regarding the accuracy comparing with that of naked-eyed detection. As the results of classification, the method of Mahalanobis distance was shown as more efficient than other methods and the accuracy of classification was higher when adding texture information. Hence the more effective

  2. High-utilizing Crohn's disease patients under psychosomatic therapy*

    PubMed Central

    Deter, Hans-Christian; von Wietersheim, Jörn; Jantschek, Günther; Burgdorf, Friederike; Blum, Brigitta; Keller, Wolfram

    2008-01-01

    Objective Few studies have been published on health care utilization in Crohn's disease and the influence of psychological treatment on high utilizers. Methods The present sub study of a prospective multi center investigation conducted in 87 of 488 consecutive Crohn's disease (CD) patients was designed to investigate the influence of the course of Crohn's disease on health care utilization (hospital days (HD) and sick leave days (SLD) collected by German insurance companies) and to examine the conditions of high-utilizing patients. Predictors of health care utilization should be selected. Based on a standardized somatic treatment, high health care utilizing patients of the psychotherapy and control groups should be compared before and after a one-year treatment. Results Multivariate regression analysis identified disease activity at randomization as an important predictor of the clinical course (r2 = 0.28, p < 0.01). Health care utilization correlated with duration of disease (p < 0.04), but the model was not significant (r2 = 0.15, p = 0.09). The patients' level of anxiety, depression and lack of control at randomization predicted their health-related quality of life at the end of the study (r2 = 0.51, p < 0.00001). Interestingly, steroid intake and depression (t1) predicted the combined outcome measure (clinical course, HRQL, health care utilization) of Crohn's disease at the end of the study (r2 = 0.22, p < 0.001). Among high utilizers, a significantly greater drop in HD (p < 0.03) and in mean in SLD were found in the treatment compared to the control group. Conclusion The course of Crohn's disease is influenced by psychological as well as somatic factors; especially depression seems important here. A significant drop of health care utilization demonstrates the benefit of psychological treatment in the subgroup of high-utilizing CD patients. Further studies are needed to replicate the findings of the clinical outcome in this CD subgroup. PMID:18851749

  3. Parkinson's disease: diagnostic utility of volumetric imaging.

    PubMed

    Lin, Wei-Che; Chou, Kun-Hsien; Lee, Pei-Lin; Tsai, Nai-Wen; Chen, Hsiu-Ling; Hsu, Ai-Ling; Chen, Meng-Hsiang; Huang, Yung-Cheng; Lin, Ching-Po; Lu, Cheng-Hsien

    2017-04-01

    This paper aims to examine the effectiveness of structural imaging as an aid in the diagnosis of Parkinson's disease (PD). High-resolution T 1-weighted magnetic resonance imaging was performed in 72 patients with idiopathic PD (mean age, 61.08 years) and 73 healthy subjects (mean age, 58.96 years). The whole brain was parcellated into 95 regions of interest using composite anatomical atlases, and region volumes were calculated. Three diagnostic classifiers were constructed using binary multiple logistic regression modeling: the (i) basal ganglion prior classifier, (ii) data-driven classifier, and (iii) basal ganglion prior/data-driven hybrid classifier. Leave-one-out cross validation was used to unbiasedly evaluate the predictive accuracy of imaging features. Pearson's correlation analysis was further performed to correlate outcome measurement using the best PD classifier with disease severity. Smaller volume in susceptible regions is diagnostic for Parkinson's disease. Compared with the other two classifiers, the basal ganglion prior/data-driven hybrid classifier had the highest diagnostic reliability with a sensitivity of 74%, specificity of 75%, and accuracy of 74%. Furthermore, outcome measurement using this classifier was associated with disease severity. Brain structural volumetric analysis with multiple logistic regression modeling can be a complementary tool for diagnosing PD.

  4. Preliminary design of Laser Utilizing Communications Equipment (LUCE) installed on Optical Inter-Orbit Communications Engineering Test Satellite (OICETS)

    NASA Astrophysics Data System (ADS)

    Nakagawa, Keizo; Yamamoto, Akio

    1995-04-01

    The Laser Utilizing Communications Equipment (LUCE) installed on the Optical Inter-orbit Communications Engineering Test Satellite (OICETS) has been developed by NASDA (National Space Development Agency of Japan) in order to perform the inter-satellite optical link experiment with ARTEMIS (Advanced Relay and Technology Mission Satellite) of ESA (European Space Agency). To acquire the acquisition, tracking and pointing technology of an optical link is aimed by this in-orbit experiment. The preliminary design of OICETS including LUCE was finished and its result is reported in this paper.

  5. Earth Observatory Satellite system definition study. Report no. 6: Space shuttle interfaces/utilization

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The impacts of achieving compatibility of the Earth Observatory Satellite (EOS) with the space shuttle and the potential benefits of space shuttle utilization are discussed. Mission requirements and mission suitability, including the effects of multiple spacecraft missions, are addressed for the full spectrum of the missions. Design impact is assessed primarily against Mission B, but unique requirements reflected by Mission A, B, and C are addressed. The preliminary results indicated that the resupply mission had the most pronounced impact on spacecraft design and cost. Program costs are developed for the design changes necessary to achieve EOS-B compatibility with Space Shuttle operations. Non-recurring and recurring unit costs are determined, including development, test, ground support and logistics, and integration efforts. Mission suitability is addressed in terms of performance, volume, and center of gravity compatibility with both space shuttle and conventional launch vehicle capabilities.

  6. A laser communication experiment utilizing the ACT satellite and an airborne laser transceiver

    NASA Technical Reports Server (NTRS)

    Provencher, Charles E., Jr.; Spence, Rodney L.

    1988-01-01

    The launch of a laser communication transmitter package into geosynchronous Earth orbit onboard the Advanced Communications Technology Satellite (ACTS) will present an excellent opportunity for the experimental reception of laser communication signals transmitted from a space orbit. The ACTS laser package includes both a heterodyne transmitter (Lincoln Labs design) and a direct detection transmitter (Goddard Space Flight Center design) with both sharing some common optical components. NASA Lewis Research Center's Space Electronics Division is planning to perform a space communication experiment utilizing the GSFC direct detection laser transceiver. The laser receiver will be installed within an aircraft provided with a glass port for the reception of the signal. This paper describes the experiment and the approach to performing such an experiment. Described are the constraints placed on the NASA Lewis experiment by the performance parameters of the laser transmitter and by the ACTS spacecraft operations. The conceptual design of the receiving terminal is given; also included is the anticipated capability of the detector.

  7. Earth-satellite propagation above GHz: Papers from the 1972 spring URSI session on experiments utilizing the ATS-5 satellite

    NASA Technical Reports Server (NTRS)

    Ippolito, L. J. (Compiler)

    1972-01-01

    Papers are reported from the Special Session on Earth-Satellite Propagation Above 10 GHz, presented at The 1972 Spring Meeting of the United States National Committee, International Union of Radio Science, April 1972, Washington, D. C. This session was devoted to propagation measurements associated with the Applications Technology Satellite (ATS-5), which provided the first operational earth-space links at frequencies above 15 GHz. A comprehensive summary is presented of the major results of the ATS-5 experiment measurements and related radiometric, radar and meteorological studies. The papers are organized around seven selected areas of interest, with the results of the various investigators combined into a single paper presented by a principal author for that area. A comprehensive report is provided on the results of the ATS-5 satellite to earth transmissions. A complete list of published reports and presentations related to the ATS-5 Millimeter Wave Experiment is included.

  8. Utilizing Satellite Precipitation Products to Understand the Link Between Climate Variability and Malaria

    NASA Astrophysics Data System (ADS)

    Maggioni, V.; Mousam, A.; Delamater, P. L.; Cash, B. A.; Quispe, A.

    2015-12-01

    Malaria is a public health threat to people globally leading to 198 million cases and 584,000 deaths annually. Outbreaks of vector borne diseases such as malaria can be significantly impacted by climate variables such as precipitation. For example, an increase in rainfall has the potential to create pools of water that can serve as breeding locations for mosquitos. Peru is a country that is currently controlling malaria, but has not been able to completely eliminate the disease. Despite the various initiatives in order to control malaria - including regional efforts to improve surveillance, early detection, prompt treatment, and vector management - malaria cases in Peru have risen between 2011 and 2014. The purpose of this study is to test the hypothesis that climate variability plays a fundamental role in malaria occurrence over a 12-year period (2003-2014) in Peru. When analyzing climate variability, it is important to obtain high-quality, high-resolution data for a time series long enough to draw conclusion about how climate variables have been and are changing. Remote sensing is a powerful tool for measuring and monitoring climate variables continuously in time and space. A widely used satellite-based precipitation product, the Tropical Rainfall Measuring Mission (TRMM) Multi-satellite Precipitation Analysis (TMPA), available globally since 1998, was used to obtain 3-hourly data with a spatial resolution of 0.25° x 0.25°. The precipitation data was linked to weekly (2003-2014) malaria cases collected by health centers and available at a district level all over Peru to investigate the relationship between precipitation and the seasonal and annual variations in malaria incidence. Further studies will incorporate additional climate variables such as temperature, humidity, soil moisture, and surface pressure from remote sensing data products and climate models. Ultimately, this research will help us to understand if climate variability impacts malaria incidence

  9. Development of U.S. Government General Technical Requirements for UAS Flight Safety Systems Utilizing the Iridium Satellite Constellation

    NASA Technical Reports Server (NTRS)

    Murray, Jennifer; Birr, Richard

    2010-01-01

    This slide presentation reviews the development of technical requirements for Unmanned Aircraft Systems (UAS) utilization of the Iridium Satellite Constellation to provide flight safety. The Federal Aviation Authority (FAA) required an over-the-horizon communication standard to guarantee flight safety before permitting widespread UAS flights in the National Air Space (NAS). This is important to ensure reliable control of UASs during loss-link and over-the-horizon scenarios. The core requirement was to utilize a satellite system to send GPS tracking data and other telemetry from a flight vehicle down to the ground. Iridium was chosen as the system because it is one of the only true satellite systems that has world wide coverage, and the service has a highly reliable link margin. The Iridium system, the flight modems, and the test flight are described.

  10. Factors affecting frequency and orbit utilization by high power transmission satellite systems

    NASA Technical Reports Server (NTRS)

    Kuhns, P. W.; Miller, E. F.; Malley, T. A.

    1972-01-01

    The factors affecting the sharing of the geostationary orbit by high power (primarily television) satellite systems having the same or adjacent coverage areas and by satellites occupying the same orbit segment are examined and examples using the results of computer computations are given. The factors considered include: required protection ratio, receiver antenna patterns, relative transmitter power, transmitter antenna patterns, satellite grouping, and coverage pattern overlap. The results presented indicated the limits of system characteristics and orbit deployment which can result from mixing systems.

  11. Detection of regional air pollution episodes utilizing satellite digital data in the visual range

    NASA Technical Reports Server (NTRS)

    Burke, H.-H. K.

    1982-01-01

    Digital analyses of satellite visible data for selected high-sulfate cases over the northeastern U.S., on July 21 and 22, 1978, are compared with ground-based measurements. Quantitative information on total aerosol loading derived from the satellite digitized data using an atmospheric radiative transfer model is found to agree with the ground measurements, and it is shown that the extent and transport of the haze pattern may be monitored from the satellite data over the period of maximum intensity for the episode. Attention is drawn to the potential benefits of satellite monitoring of pollution episodes demonstrated by the model.

  12. Utilization of satellite data and regional scale numerical models in short range weather forecasting

    NASA Technical Reports Server (NTRS)

    Kreitzberg, C. W.

    1985-01-01

    Overwhelming evidence was developed in a number of studies of satellite data impact on numerical weather prediction that it is unrealistic to expect satellite temperature soundings to improve detailed regional numerical weather prediction. It is likely that satellite data over the United States would substantially impact mesoscale dynamical predictions if the effort were made to develop a composite moisture analysis system. The horizontal variability of moisture, most clearly depicited in images from satellite water vapor channels, would not be determined from conventional rawinsondes even if that network were increased by a doubling of both the number of sites and the time frequency.

  13. Detection of regional air pollution episodes utilizing satellite digital data in the visual range

    NASA Technical Reports Server (NTRS)

    Burke, H.-H. K.

    1982-01-01

    Digital analyses of satellite visible data for selected high-sulfate cases over the northeastern U.S., on July 21 and 22, 1978, are compared with ground-based measurements. Quantitative information on total aerosol loading derived from the satellite digitized data using an atmospheric radiative transfer model is found to agree with the ground measurements, and it is shown that the extent and transport of the haze pattern may be monitored from the satellite data over the period of maximum intensity for the episode. Attention is drawn to the potential benefits of satellite monitoring of pollution episodes demonstrated by the model.

  14. TRAN*STAR 2 evaluation for NOAA data buoy office, part A. [utilizing the US Navy Navigation Satellite System

    NASA Technical Reports Server (NTRS)

    1976-01-01

    The capability of the TRAN*STAR 2 receiver equipment utilizing the U.S. Navy Navigation Satellite System to provide reliable position locations with reasonable accuracy and frequency was evaluated. Two receivers, an antenna, and a test set were procured, and position fix data collected at NSTL from a fixed known location during the months of May and June. The data were processed through a computer program and analyzed. The results of the evaluation are summarized.

  15. Application of communications satellites to educational development. [technology utilization/information systems - bibliographies

    NASA Technical Reports Server (NTRS)

    Morgan, R. P.

    1975-01-01

    A summary of research is presented. The broad objectives of this interdisciplinary research effort were: (1) to assess the role of satellite communications as a means of improving education in the United States, as well as in less-developed areas of the world; (2) to generate basic knowledge which will aid in making rational decisions about satellite application in the field of education in the years ahead; (3) to devise systems and strategies for improving education; and (4) to educate individuals who will be knowledgeable about aspects of satellite communications policy which transcend any single discipline.

  16. The Impact of Physical Atmosphere on Air Quality and the Utility of Satellite Observations in Air Quality Models

    NASA Astrophysics Data System (ADS)

    Pour Biazar, A.; McNider, R. T.; Park, Y. H.; Doty, K.; Khan, M. N.; Dornblaser, B.

    2012-12-01

    Physical atmosphere significantly impacts air quality as it regulates production, accumulation, and transport of atmospheric pollutants. Consequently, air quality simulations are greatly influenced by the uncertainties that emanates from the simulation of physical atmosphere. Since air quality model predictions are increasingly being used in health studies, regulatory applications, and policy making, reducing such uncertainties in model simulations is of outmost importance. This paper describes some of the critical aspects of physical atmosphere affecting air quality models that can be improved by utilizing satellite observations. Retrievals of skin temperature, surface albedo, surface insolation, cloud top temperature and cloud reflectance obtained from the Geostationary Operational Environmental Satellite (GOES) by NASA/MSFC GOES Product Generation System (GPGS) have been utilized to improve the air quality simulations used in the State Implementation Plan (SIP) attainment demonstrations. Satellite observations of ground temperature are used to recover surface moisture and heat capacity and thereby improving model simulation of air temperature. Observations of clouds are utilized to improve the photochemical reaction rates within the photochemical model and also to assimilate clouds in the meteorological model. These techniques have been implemented and tested in some of the widely used air quality decision modeling systems such as MM5/WRF/CMAQ/CAMx. The results from these activities show significant improvements in air quality simulations.

  17. Utility of Noninvasive Markers of Fibrosis in Cholestatic Liver Diseases.

    PubMed

    Corpechot, Christophe

    2016-02-01

    Methods of liver fibrosis assessment have changed considerably in the last 20 years, and noninvasive markers now have been recognized as major first-line tools in the management of patients with chronic viral hepatitis infection. But what about the efficiency and utility of these surrogate indices for the more uncommon chronic cholestatic liver diseases, namely primary biliary cirrhosis and primary sclerosing cholangitis? This article provides clinicians with a global overview of what is currently known in the field. Both diagnostic and prognostic aspects of noninvasive markers of fibrosis in cholestatic liver diseases are presented and discussed.

  18. Predictors of resource utilization in transsphenoidal surgery for Cushing disease.

    PubMed

    Little, Andrew S; Chapple, Kristina

    2013-08-01

    The short-term cost associated with subspecialized surgical care is an increasingly important metric and economic concern. This study sought to determine factors associated with hospital charges in patients undergoing transsphenoidal surgery for Cushing disease in an effort to identify the drivers of resource utilization. The authors analyzed the Nationwide Inpatient Sample (NIS) hospital discharge database from 2007 to 2009 to determine factors that influenced hospital charges in patients who had undergone transsphenoidal surgery for Cushing disease. The NIS discharge database approximates a 20% sample of all inpatient admissions to nonfederal US hospitals. A multistep regression model was developed that adjusted for patient demographics, acuity measures, comorbidities, hospital characteristics, and complications. In 116 hospitals, 454 transsphenoidal operations were performed. The mean hospital charge was $48,272 ± $32,060. A multivariate regression model suggested that the primary driver of resource utilization was length of stay (LOS), followed by surgeon volume, hospital characteristics, and postoperative complications. A 1% increase in LOS increased hospital charges by 0.60%. Patient charges were 13% lower when performed by high-volume surgeons compared with low-volume surgeons and 22% lower in large hospitals compared with small hospitals. Hospital charges were 12% lower in cases with no postoperative neurological complications. The proposed model accounted for 46% of hospital charge variance. This analysis of hospital charges in transsphenoidal surgery for Cushing disease suggested that LOS, hospital characteristics, surgeon volume, and postoperative complications are important predictors of resource utilization. These findings may suggest opportunities for improvement.

  19. Military Hydrology. Report 8. Feasibility of Utilizing Satellite and Radar Data in Hydrologic Forecasting.

    DTIC Science & Technology

    1985-09-01

    Martin, D. W., Stout, J., and Sikdar , 1). N. 1976. "Rainfall Estimation from Geo- synchronous Satellite Imagery During Daylight Hours," NOAA...Technical Report ERL 356-WMPO 7, US Department of Commerce. Griffith, C. G., Woodley, W. L., Grube, P. G., Martin, D. W., Stout, J., and Sikdar . D. N. 1978...34 Journal of Applied Meteorology, Vol 5, pp 161-164. Stout, J., Martin, D., and Sikdar , D. N. 1979. "Estimating Rain with Ceosynchronous Satellite Images

  20. Investigation of biomass burning and aerosol loading and transport in South America utilizing geostationary satellites

    NASA Technical Reports Server (NTRS)

    Menzel, Paul; Prins, Elaine

    1995-01-01

    This study attempts to assess the extent of burning and associated aerosol transport regimes in South America and the South Atlantic using geostationary satellite observations, in order to explore the possible roles of biomass burning in climate change and more directly in atmospheric chemistry and radiative transfer processes. Modeling and analysis efforts have suggested that the direct and indirect radiative effects of aerosols from biomass burning may play a major role in the radiative balance of the earth and are an important factor in climate change calculations. One of the most active regions of biomass burning is located in South America, associated with deforestation in the selva (forest), grassland management, and other agricultural practices. As part of the NASA Aerosol Interdisciplinary Program, we are utilizing GOES-7 (1988) and GOES-8 (1995) visible and multispectral infrared data (4, 11, and 12 microns) to document daily biomass burning activity in South America and to distinguish smoke/aerosols from other multi-level clouds and low-level moisture. This study catalogues the areal extent and transport of smoke/aerosols throughout the region and over the Atlantic Ocean for the 1988 (July-September) and 1995 (June-October) biomass burning seasons. The smoke/haze cover estimates are compared to the locations of fires to determine the source and verify the haze is actually associated with biomass burning activities. The temporal resolution of the GOES data (half-hourly in South America) makes it possible to determine the prevailing circulation and transport of aerosols by considering a series of visible and infrared images and tracking the motion of smoke, haze and adjacent clouds. The study area extends from 40 to 70 deg W and 0 to 40 deg S with aerosol coverage extending over the Atlantic Ocean when necessary. Fire activity is estimated with the GOES Automated Biomass Burning Algorithm (ABBA). To date, our efforts have focused on GOES-7 and GOES-8 ABBA

  1. Utility and Value of Satellite-Based Frost Forecasting for Kenya's Tea Farming Sector

    NASA Astrophysics Data System (ADS)

    Morrison, I.

    2016-12-01

    Frost damage regularly inflicts millions of dollars of crop losses in the tea-growing highlands of western Kenya, a problem that the USAID/NASA Regional Visualization and Monitoring System (SERVIR) program is working to mitigate through a frost monitoring and forecasting product that uses satellite-based temperature and soil moisture data to generate up to three days of advanced warning before frost events. This paper presents the findings of a value of information (VOI) study assessing the value of this product based on Kenyan tea farmers' experiences with frost and frost-damage mitigation. Value was calculated based on historic trends of frost frequency, severity, and extent; likelihood of warning receipt and response; and subsequent frost-related crop-loss aversion. Quantification of these factors was derived through inferential analysis of survey data from 400 tea-farming households across the tea-growing regions of Kericho and Nandi, supplemented with key informant interviews with decision-makers at large estate tea plantations, historical frost incident and crop-loss data from estate tea plantations and agricultural insurance companies, and publicly available demographic and economic data. At this time, the product provides a forecasting window of up to three days, and no other frost-prediction methods are used by the large or small-scale farmers of Kenya's tea sector. This represents a significant opportunity for preemptive loss-reduction via Earth observation data. However, the tea-growing community has only two realistic options for frost-damage mitigation: preemptive harvest of available tea leaves to minimize losses, or skiving (light pruning) to facilitate fast recovery from frost damage. Both options are labor-intensive and require a minimum of three days of warning to be viable. As a result, the frost forecasting system has a very narrow margin of usefulness, making its value highly dependent on rapid access to the warning messages and flexible access

  2. Quality of life utilities for pelvic inflammatory disease health states.

    PubMed

    Smith, Kenneth J; Tsevat, Joel; Ness, Roberta B; Wiesenfeld, Harold C; Roberts, Mark S

    2008-03-01

    Quality of life utilities for health states associated with pelvic inflammatory disease (PID) have been estimated but not directly measured. Utilities for PID could have important implications on the cost-effectiveness of interventions to prevent and manage this disease. We obtained, in women with versus without a history of PID, visual analogue scale (VAS) and time-tradeoff (TTO) valuations for 5 PID-associated health states: ambulatory PID treatment, hospital PID treatment, ectopic pregnancy, chronic pelvic pain, and infertility. Subjects read brief scenarios describing the medical, functional, and social activity effects typically associated with each state, then gave valuations in the order above. Health state valuations were obtained from 56 women with and 150 women without a PID history. Subjects with a PID history had significantly lower mean valuations (P <0.05) on the VAS for ectopic pregnancy (0.55 vs. 0.63), pelvic pain (0.45 vs. 0.53), and infertility (0.53 vs. 0.66) but not on the TTO; VAS differences remained significant when controlling for demographic and childbearing characteristics. VAS and TTO valuations were similar in women with versus without a history of PID for the ambulatory and hospital PID treatment health states. PID has substantial impact on utility. In addition, some PID-related health states are valued less by women who have experienced PID, which could affect cost-effectiveness analyses of PID treatments when examined from the societal versus patient perspective.

  3. Detection of regional air pollution episodes utilizing satellite data in the visual range

    NASA Technical Reports Server (NTRS)

    Bowley, C. J.; Burke, H. K.; Barnes, J. C.

    1981-01-01

    A comparative analysis of satellite-observed haze patterns and ground-based aerosol measurements is carried out for July 20-23, 1978. During this period, a significant regional air pollution episode existed across the northeastern United States, accompanied by widespread haze, reduced surface visibility, and elevated sulfate levels measured by the Sulfate Regional Experiment (SURE) network. The results show that the satellite-observed haze patterns correlate closely with the area of reported low surface visibility (less than 4 mi) and high sulfate levels. Quantitative information on total aerosol loading derived from the satellite-digitized data, using an atmospheric radiative transfer model, agrees well with the results obtained from the ground-based measurements.

  4. Space-shuttle interfaces/utilization. Earth Observatory Satellite system definition study (EOS)

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The economic aspects of space shuttle application to a representative Earth Observatory Satellite (EOS) operational mission in the various candidate Shuttle modes of launch, retrieval, and resupply are discussed. System maintenance of the same mission capability using a conventional launch vehicle is also considered. The studies are based on application of sophisticated Monte Carlo mission simulation program developed originally for studies of in-space servicing of a military satellite system. The program has been modified to permit evaluation of space shuttle application to low altitude EOS missions in all three modes. The conclusions generated by the EOS system study are developed.

  5. Instantaneous Shoreline Extraction Utilizing Integrated Spectrum and Shadow Analysis From LiDAR Data and High-resolution Satellite Imagery

    NASA Astrophysics Data System (ADS)

    Lee, I.-Chieh

    manually connected, for its length was less than 3% of the total shoreline length in our dataset. Secondly, the parameters for satellite image classification needed to be manually determined. The need for manpower was significantly less compared to the ground surveying or aerial photogrammetry. The first phase of shoreline extraction was to utilize Normalized Difference Vegetation Index (NDVI), Mean-Shift segmentation on the coordinate (X, Y, Z), and attributes (multispectral bands from satellite images) of the LiDAR points to classify each LiDAR point into land or water surface. Boundary of the land points were then traced to create the shoreline. The second phase of shoreline extraction solely from satellite images utilized spectrum, NDVI, and shadow analysis to classify the satellite images into classes. These classes were then refined by mean-shift segmentation on the panchromatic band. By tracing the boundary of the water surface, the shoreline can be created. Since these two shorelines may represent different shoreline instances in time, evaluating the changes of shoreline was the first to be done. Then an independent scenario analysis and a procedure are performed for the shoreline of each of the three conditions: in the process of erosion, in the process of accession, and remaining the same. With these three conditions, we could analysis the actual terrain type and correct the classification errors to obtain a more accurate shoreline. Meanwhile, methods of evaluating the quality of shorelines had also been discussed. The experiment showed that there were three indicators could best represent the quality of the shoreline. These indicators were: (1) shoreline accuracy, (2) land area difference between extracted shoreline and ground truth shoreline, and (3) bias factor from shoreline quality metrics.

  6. Utilization of Satellite Data in Land Surface Hydrology: Sensitivity and Assimilation

    NASA Technical Reports Server (NTRS)

    Lakshmi, Venkataraman; Susskind, Joel

    1999-01-01

    This paper investigates the sensitivity of potential evapotranspiration to input meteorological variables, viz- surface air temperature and surface vapor pressure. The sensitivity studies have been carried out for a wide range of land surface variables such as wind speed, leaf area index and surface temperatures. Errors in the surface air temperature and surface vapor pressure result in errors of different signs in the computed potential evapotranspiration. This result has implications for use of estimated values from satellite data or analysis of surface air temperature and surface vapor pressure in large scale hydrological modeling. The comparison of cumulative potential evapotranspiration estimates using ground observations and satellite observations over Manhattan, Kansas for a period of several months shows very little difference between the two. The cumulative differences between the ground based and satellite based estimates of potential evapotranspiration amounted to less that 20mm over a 18 month period and a percentage difference of 15%. The use of satellite estimates of surface skin temperature in hydrological modeling to update the soil moisture using a physical adjustment concept is studied in detail including the extent of changes in soil moisture resulting from the assimilation of surface skin temperature. The soil moisture of the surface layer is adjusted by 0.9mm over a 10 day period as a result of a 3K difference between the predicted and the observed surface temperature. This is a considerable amount given the fact that the top layer can hold only 5mm of water.

  7. ERTS-B (Earth Resources Technology Satellite). [spacecraft design remote sensor description, and technology utilization

    NASA Technical Reports Server (NTRS)

    1975-01-01

    Mission plans and objectives of the ERTS 2 Satellite are presented. ERTS 2 follow-on investigations in various scientific disciplines including agriculture, meteorology, land-use, geology, water resources, oceanography, and environment are discussed. Spacecraft design and its sensors are described along with the Delta launch vehicle and launch operations. Applications identified from ERTS 1 investigations are summarized.

  8. The potential utility of land surface modeling and data assimilation for satellite soil moisture validation activities

    USDA-ARS?s Scientific Manuscript database

    In the past five years, a number of different modeling and/or data assimilation strategies have been introduced to conduct validation/evaluation of satellite-based surface soil moisture retrievals. These strategies can be (roughly) separated into three separate categories: 1) triple collocation (TC)...

  9. Analysis of the proposed utilization of TDRS system by the HEAO-C satellite

    NASA Technical Reports Server (NTRS)

    Weathers, G.

    1974-01-01

    The primary function of the study was to assess the impact upon the HEAO telecommunications system of the proposed relay satellite-to-ground-link configuration. The system is designed to perform the function of most of the NASA ground tracking and communications network at a net cost savings for NASA.

  10. Utility of Satellite Remote Sensing for Land-Atmosphere Coupling and Drought Metrics

    NASA Astrophysics Data System (ADS)

    Roundy, J. K.; Santanello, J. A., Jr.

    2016-12-01

    In a changing climate, the potential for increased frequency and duration of drought implies devastating impacts on many aspects of society. The negative impacts of drought can be reduced through informing sustainable water management made possible by real-time monitoring and prediction. The refinement of forecast models is best realized through large-scale observation based datasets, yet there are few of these datasets currently available. The Coupling Drought Index (CDI) has great potential for the application of satellite data to metrics of Land-Atmosphere (L-A) coupling and drought. Specifically, NASA's AQUA satellite and retrievals of soil moisture and lower tropospheric temperature and humidity properties provide all the needed variables to derive the CDI solely from satellite data. This work demonstrates the application of the CDI to satellite and in-situ observations and indicates that the CDI can provide an early warning to drought development and recovery while serving as a unique drought-monitoring resource that can be calculated entirely from remote sensing data. The combination of satellite and reanalysis data also indicates that parts of the Western U.S. may see an increase in drought conditions, while the Northern Great Lakes could see a decrease in drought conditions if current trends continue. From a global perspective, South America, South and West Africa, Northern Australia and the Pacific Islands will see a decrease in drought conditions, while parts of North Africa, the Middle East and Central Eurasia will see an increase in drought conditions. The derived L-A metrics also indicate that the frequency of dry coupling events is most impacted by the convective triggering potential (i.e. stability of the lower troposphere) while the duration of such events is driven more by the soil moisture condition.

  11. Multiple access techniques and spectrum utilization of the Globalstar mobile satellite system

    NASA Astrophysics Data System (ADS)

    Louie, Ming; Rouffet, Denis; Gilhousen, Klein S.

    1992-03-01

    The Globalstar LEO satellite system is described in terms of the commercial application of multiple-access and other technologies for cellular telephones. Attention is given to the simultaneous spectrum usage in several bands and the use of time-domain duplexing to achieve multiple access in both systems A and B. The efficiency of the code-division multiple-access (CDMA) technique employed is demonstrated in a discussion of the total system capacity for the 24-satellite constellation. CDMA is shown to allow frequency reuse of adjacent beams with marginal isolation, capacity increases by means of the voice-activity factor, and spectrum sharing among different operators. Also employed in the system are frequency- and time-division multiple-access technologies which enhance the efficiency of the modulation and multiple-access system.

  12. A laser communication experiment utilizing the ACT satellite and an airborne laser transceiver

    NASA Technical Reports Server (NTRS)

    Provencher, C.; Spence, Rod

    1988-01-01

    The Advanced Communications Technology Satellite (ACTS) will carry a laser communications transmitter package in order to attempt the experimental reception of signals transmitted from earth orbit. The ACTS laser package includes both a heterodyne transmitter and a direct-detection transmitter. The laser receiver will be installed in an aircraft that is fitted with the requisite signal window. The anticipated capability of this signal detector is noted.

  13. Association of Satellites with a Mastrevirus in Natural Infection: Complexity of Wheat Dwarf India Virus Disease

    PubMed Central

    Kumar, Jitendra; Kumar, Jitesh; Singh, Sudhir P.

    2014-01-01

    Dwarf India Virus (WDIV), isolated from two distant locations in India. This study reports the first identification of the satellites in a monocot plant. The satellites enhanced accumulation of WDIV and severity of disease symptoms. The satellites lowered the concentration of virus-specific small RNAs in wheat plants, indicating their silencing suppressor activity. The involvement of the satellites in symptom severity of the mastrevirus can have implications in the form of economic impact of the virus on crop yield. Understanding the role of the satellites in disease severity is important for developing disease management strategies. PMID:24719407

  14. Association of satellites with a mastrevirus in natural infection: complexity of Wheat dwarf India virus disease.

    PubMed

    Kumar, Jitendra; Kumar, Jitesh; Singh, Sudhir P; Tuli, Rakesh

    2014-06-01

    (WDIV), isolated from two distant locations in India. This study reports the first identification of the satellites in a monocot plant. The satellites enhanced accumulation of WDIV and severity of disease symptoms. The satellites lowered the concentration of virus-specific small RNAs in wheat plants, indicating their silencing suppressor activity. The involvement of the satellites in symptom severity of the mastrevirus can have implications in the form of economic impact of the virus on crop yield. Understanding the role of the satellites in disease severity is important for developing disease management strategies. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  15. a Class of Regression-Cum Estimators in Two-Phase Sampling for Utilizing Information from High Resolution Satellite Data

    NASA Astrophysics Data System (ADS)

    Handique, B. K.

    2012-07-01

    Two-phase sampling design offers a variety of possibilities for effective use of auxiliary information such as those from high resolution remote sensing data. Continuous satellite data with large area coverage provide scope for deriving population values of the auxiliary variables, which can effectively be used for estimating the population parameters of the variable of interest. This study has been made to examine the possibilities of different forms of auxiliary information derived from remote sensing data in two-phase sampling design and suggest an appropriate estimator that will be of broad interest and applications. A new class of regression-cum-ratio estimators has been proposed for two-phase sampling using information on two auxiliary variables derived from high resolution satellite data. The bias and the mean square error (MSE) of the proposed estimators have been obtained up to first order approximation. Efficiency comparison of the proposed estimators has been made with some traditional estimators. The proposed estimator is found to be more efficient than the usual regression and ratio estimators. Numerical illustration has been carried out to examine the efficiency of the estimator in case of forest timber volume estimation utilizing tree crown diameter and tree height as auxiliary variables. It is shown that these estimators can be employed in a variety of conditions where there is strong correlation of satellite derived information with sample based ground measurements and when the cost of ground measurements is relatively high.

  16. a Comparative Study on Utilization of Multi-Sensor Satellite Data to Detect Potential Fishing Zone (pfz)

    NASA Astrophysics Data System (ADS)

    Balaguru, B.; Ramakrishnan, S. S.; Vidhya, R.; Thanabalan, T.

    2014-11-01

    The satellite oceanography reveals the rolls on Potential Fishing Zone (PFZ) advisories in India is limited by the availability of the satellite data during the cloudy days and for the cloudy areas, because of the inability of the passive sensors to pass through the clouds. However, there is a huge demand from the fishermen community to provide PFZ advisories on cloudy days / monsoon period also as the period corresponds to the peak fishing season. Keeping in view of the demand and availability of the optimally interpolated merged product from Altimetry, it is proposed to utilize 4 km SST product obtained from the AVHRR. In view of this, a comparative analysis has been carried out on the feasibility of utilization of the Altimetry product for identification of PFZ Advisories. The analysis is carried out the synergize study on existing in AVHRR SST product are really matching with the high resolution EKE and SSHA products derived from Altimetry. From the analysis it was found that the Altimetry product is suitable for identifying cold core generation of waters for PFZ advisories with certain limitations. Also persistence of the ocean color environmental variables is cross-verified with catch weight observed from In-situ observation. The overall analysis derived from ocean color and altimetry products for delineating potential fishing zones enhance flawless information for future research.

  17. Predicting the risk of coral disease outbreak using satellite SST.

    NASA Astrophysics Data System (ADS)

    Heron, S. F.; Willis, B. L.; Skirving, W. J.; Page, C. A.; Eakin, C. M.; Miller, I. R.; Christensen, T. R.; Gledhill, D. K.; Liu, G.; Morgan, J. A.; Parker, B. A.; Strong, A. E.

    2009-05-01

    Several environmental parameters have been linked to outbreaks of coral disease. Here we describe the influence of remotely-sensed summer and winter temperatures, as well as local observations of coral cover, to predict the risk of White Syndrome disease outbreaks on the Great Barrier Reef, Australia. Coral disease is an emerging risk to coral reef ecosystems that is likely to escalate with ocean warming due to climate change. The aim of this work is to provide reef managers with an expert system for predicting disease risk on coral reefs as far as six months in advance of summer outbreaks.

  18. Aviation utilization of geostationary satellites for the augmentation to GPS: Ranging and data link

    NASA Astrophysics Data System (ADS)

    Fuller, Richard Andrew, II

    2000-08-01

    The Wide Area Augmentation System (WAAS) is a GPS-based navigation aid currently under development by the Federal Aviation Administration (FAA). WAAS will provide corrections to aviation users for the GPS clock, its ephemeris, and for the delay in its signal as it passes through the ionosphere. These corrections will be broadcast to users throughout the United States via geostationary satellites. A master station that combines data from a continental network of reference GPS receivers will create these messages. The geostationary satellites serve both as wide-area differential GPS data links as well as additional ranging sources. The data message stream of WAAS enhances the accuracy and integrity of the GPS signal for aviation. Simultaneously, the satellite ranging-source increases the percentage of time that the precise signal is available. In this way, WAAS provides needed improvements in four metrics over the standard GPS signal: accuracy, integrity, availability, and continuity. The ranging function, described above, requires an estimate of the position of the geostationary satellite. This dissertation presents a novel technique for generating this position estimate. This technique is designed to provide high integrity performance in the user position domain and operates in real-time. As such, it contrasts classical orbit determination techniques that have no integrity requirement, are not designed to optimize performance in the user position domain, and usually have no real-time requirement. Our estimator is evaluated using real data from the FAA's National Satellite Test Bed (NSTB). The WAAS Signal-In-Space (SIS) has a limited data message bandwidth of 250 bits-per-second. This data bandwidth was chosen to balance two concerns. First, the power of the signal must not be so strong that it jams GPS. Second, the signal must provide the minimum amount of information necessary to ensure adequate accuracy and integrity for aviation users over the entire

  19. Clinical Utility of Serologic Testing for Celiac Disease in Ontario

    PubMed Central

    2010-01-01

    tests in the diagnosis celiac disease? What is the clinical validity of serologic tests in the diagnosis of celiac disease? The clinical validity was defined as the ability of the test to change diagnosis. What is the clinical utility of serologic tests in the diagnosis of celiac disease? The clinical utility was defined as the impact of the test on decision making. What is the budget impact of serologic tests in the diagnosis of celiac disease? What is the cost-effectiveness of serologic tests in the diagnosis of celiac disease? Methods Literature Search A literature search was performed on November 13th, 2009 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published from January 1st 2003 and November 13th 2010. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Articles with unknown eligibility were reviewed with a second clinical epidemiologist, then a group of epidemiologists until consensus was established. The quality of evidence was assessed as high, moderate, low or very low according to GRADE methodology. Inclusion Criteria Inclusion Criteria Exclusion Criteria Studies that evaluated diagnostic accuracy, i.e., both sensitivity and specificity of serology tests in the diagnosis of celiac disease. Study population consisted of untreated patients with symptoms consistent with celiac disease. Studies in which both serologic celiac disease tests and small bowel biopsy (gold standard) were used in all subjects. Systematic reviews, meta-analyses, randomized controlled trials, prospective observational studies, and retrospective cohort studies. At least 20 subjects included in

  20. Environmental waste site characterization utilizing aerial photographs and satellite imagery: Three sites in New Mexico, USA

    SciTech Connect

    Van Eeckhout, E.; Pope, P.; Becker, N.; Wells, B.; Lewis, A.; David, N.

    1996-04-01

    The proper handling and characterization of past hazardous waste sites is becoming more and more important as world population extends into areas previously deemed undesirable. Historical photographs, past records, current aerial satellite imagery can play an important role in characterizing these sites. These data provide clear insight into defining problem areas which can be surface samples for further detail. Three such areas are discussed in this paper: (1) nuclear wastes buried in trenches at Los Alamos National Laboratory, (2) surface dumping at one site at Los Alamos National Laboratory, and (3) the historical development of a municipal landfill near Las Cruces, New Mexico.

  1. Central electrical utility power for a satellite ring city in low earth orbit space

    NASA Technical Reports Server (NTRS)

    Myers, Ira T.; Faymon, Karl A.; Patton, A. D.

    1989-01-01

    Information is given in viewgraph form on central electrical power for a satellite ring city, defined as a group of large free flyers of 10 to 20 units with perhaps 100 people in each unit, and organized in a circle so that power can be fed from a central location. The free flyers would be located at 300 to 700 miles in altitude, and spaced about a kilometer apart. Potential activities of a ring city are listed as well as the electrical power needs. Information is given on costs and individual and centralized solar arrays and nuclear reactor systems.

  2. Central electrical utility power for a satellite ring city in low earth orbit space

    NASA Astrophysics Data System (ADS)

    Myers, Ira T.; Faymon, Karl A.; Patton, A. D.

    1989-07-01

    Information is given in viewgraph form on central electrical power for a satellite ring city, defined as a group of large free flyers of 10 to 20 units with perhaps 100 people in each unit, and organized in a circle so that power can be fed from a central location. The free flyers would be located at 300 to 700 miles in altitude, and spaced about a kilometer apart. Potential activities of a ring city are listed as well as the electrical power needs. Information is given on costs and individual and centralized solar arrays and nuclear reactor systems.

  3. Earth Observatory Satellite system definition study. Report 6: Space shuttle interfaces/utilization

    NASA Technical Reports Server (NTRS)

    1974-01-01

    An analysis was conducted to determine the compatibility of the Earth Observatory Satellite (EOS) with the space shuttle. The mechanical interfaces and provisions required for a launch or retrieval of the EOS by the space shuttle are summarized. The space shuttle flight support equipment required for the operation is defined. Diagrams of the space shuttle in various configurations are provised to show the mission capability with the EOS. The subjects considered are as follows: (1) structural and mechanical interfaces, (2) spacecraft retention and deployment, (3) spacecraft retrieval, (4) electrical interfaces, (5) payload shuttle operations, (6) shuttle mode cost analysis, (7) shuttle orbit trades, and (8) safety considerations.

  4. Coping strategies utilized by adolescents with end stage renal disease.

    PubMed

    Snethen, Julia A; Broome, Marion E; Kelber, Sheryl; Warady, Bradley A

    2004-01-01

    Children and adolescents with end stage renal disease (ESRD) require life-long treatment. The purpose of this descriptive investigation was to identify coping strategies that adolescents with ESRD use to manage their chronic illness. Participants for this investigation were 35 adolescents, 13-18 years of age, with ESRD. The A-COPE survey instrument was used in a clinical and camp setting to measure the coping strategies used by adolescents with ESRD. Analyses revealed that adolescents with ESRD utilized a variety of coping strategies to manage the stresses of living with their chronic condition. Personal characteristics of gender, transplant status, age, and religious views were significantly related to the coping strategies the adolescents reported using.

  5. Utilizing NASA Satellite Missions to Identify Bark Beetle Infestation in Sequoia National Park

    NASA Astrophysics Data System (ADS)

    Newcomer, M. E.; Bird, J. E.; Sabatine, S. M.; Sady, G. C.; Stalzer, A. M.; Wheeler, T. A.; Skiles, J. W.; Schmidt, C.

    2009-12-01

    Bark beetle-induced tree mortality has increased over the last few decades, exacerbated by below-average precipitation and a loss of soil nutrients, forcing park managers to improve bark beetle monitoring techniques. Bark beetle dynamics were investigated during summer 2009 at 32 sites within Sequoia National Park, California with the aim of correlating field data with satellite imagery to provide forest managers with a more efficient methodology for tracking, monitoring, and forecasting bark beetle outbreaks. Field parameters included visual assessments of the presence and degree of bark beetle-induced mortality and percent canopy cover. Ancillary data such as relative leaf chlorophyll concentration and soil nutrients including sodium [Na+], nitrate [NO3-], and potassium [K+] were collected for each 15 × 15 meter plot. The relationship between bark beetle attacks and potassium [K+] shows higher concentrations in healthy areas. Additionally, algorithms from three satellites were used to identify areas of moisture and vegetation stress; including the Ratio Vegetation Index (RVI) from ASTER, Enhanced Wetness Difference Index (EWDI) from Landsat Thematic Mapper (TM5), Disturbance Index (DI) from MODIS, and four other vegetation indices from Landsat TM5. Vegetation indices show uniform stress across various years.

  6. Modeling DGNSS Pseudo-Range Correction Messages by Utilizing Satellite Repeat Time.

    PubMed

    Sohn, Dong-Hyo; Park, Kwan-Dong; Tae, Hyunu

    2017-04-11

    We developed and validated a pseudo-range correction (PRC) modeling system that can prevent degradation of positioning accuracy even in situations where one cannot obtain PRC messages for Differential Global Navigation Satellite System (DGNSS). A PRC modeling scheme was devised based on the repeat time of GNSS satellites and previously-collected PRC data. The difference between the modeled and real PRC values observed at the reference station showed a bias error of about ±1.0 m and a root mean square error (RMSE) less than 1.5 m. When we applied the predicted PRC to Differential Global Positioning System (DGPS) and Differential BeiDou (DBDS) positioning, horizontal RMSE values were at a level of 1.0 m, while vertical RMSE was in the range of 1.8-3.0 m. We found that modelled PRCs can provide positioning results similar to those based on real PRCs and can provide significant improvement over standalone positioning without PRCs.

  7. Modeling DGNSS Pseudo-Range Correction Messages by Utilizing Satellite Repeat Time

    PubMed Central

    Sohn, Dong-Hyo; Park, Kwan-Dong; Tae, Hyunu

    2017-01-01

    We developed and validated a pseudo-range correction (PRC) modeling system that can prevent degradation of positioning accuracy even in situations where one cannot obtain PRC messages for Differential Global Navigation Satellite System (DGNSS). A PRC modeling scheme was devised based on the repeat time of GNSS satellites and previously-collected PRC data. The difference between the modeled and real PRC values observed at the reference station showed a bias error of about ±1.0 m and a root mean square error (RMSE) less than 1.5 m. When we applied the predicted PRC to Differential Global Positioning System (DGPS) and Differential BeiDou (DBDS) positioning, horizontal RMSE values were at a level of 1.0 m, while vertical RMSE was in the range of 1.8–3.0 m. We found that modelled PRCs can provide positioning results similar to those based on real PRCs and can provide significant improvement over standalone positioning without PRCs. PMID:28398247

  8. Utility of Satellite Magnetic Observations for Estimating Near-Surface Magnetic Anomalies

    NASA Technical Reports Server (NTRS)

    Kim, Hyung Rae; vonFrese, Ralph R. B.; Taylor, Patrick T.; Kim, Jeong Woo; Park, Chan Hong

    2003-01-01

    Regional to continental scale magnetic anomaly maps are becoming increasingly available from airborne, shipborne, and terrestrial surveys. Satellite data are commonly considered to fill the coverage gaps in regional compilations of these near-surface surveys. For the near-surface Antarctic magnetic anomaly map being produced by the Antarctic Digital Magnetic Anomaly Project (ADMAP), we show that near-surface magnetic anomaly estimation is greatly enhanced by the joint inversion of the near-surface data with the satellite observations relative to the conventional technique such as minimum curvature. Orsted observations are especially advantageous relative to the Magsat data that have order-of-magnitude greater measurement errors, albeit at much lower orbital altitudes. CHAMP is observing the geomagnetic field with the same measurement accuracy as the Orsted mission, but at the lower orbital altitudes covered by Magsat. Hence, additional significant improvement in predicting near-surface magnetic anomalies can result as these CHAMP data are available. Our analysis also suggests that considerable new insights on the magnetic properties of the lithosphere may be revealed by a further order-of-magnitude improvement in the accuracy of the magnetometer measurements at minimum orbital altitude.

  9. Accessing and Utilizing Remote Sensing Data for Vectorborne Infectious Diseases Surveillance and Modeling

    NASA Technical Reports Server (NTRS)

    Kiang, Richard; Adimi, Farida; Kempler, Steven

    2008-01-01

    Background: The transmission of vectorborne infectious diseases is often influenced by environmental, meteorological and climatic parameters, because the vector life cycle depends on these factors. For example, the geophysical parameters relevant to malaria transmission include precipitation, surface temperature, humidity, elevation, and vegetation type. Because these parameters are routinely measured by satellites, remote sensing is an important technological tool for predicting, preventing, and containing a number of vectorborne infectious diseases, such as malaria, dengue, West Nile virus, etc. Methods: A variety of NASA remote sensing data can be used for modeling vectorborne infectious disease transmission. We will discuss both the well known and less known remote sensing data, including Landsat, AVHRR (Advanced Very High Resolution Radiometer), MODIS (Moderate Resolution Imaging Spectroradiometer), TRMM (Tropical Rainfall Measuring Mission), ASTER (Advanced Spaceborne Thermal Emission and Reflection Radiometer), EO-1 (Earth Observing One) ALI (Advanced Land Imager), and SIESIP (Seasonal to Interannual Earth Science Information Partner) dataset. Giovanni is a Web-based application developed by the NASA Goddard Earth Sciences Data and Information Services Center. It provides a simple and intuitive way to visualize, analyze, and access vast amounts of Earth science remote sensing data. After remote sensing data is obtained, a variety of techniques, including generalized linear models and artificial intelligence oriented methods, t 3 can be used to model the dependency of disease transmission on these parameters. Results: The processes of accessing, visualizing and utilizing precipitation data using Giovanni, and acquiring other data at additional websites are illustrated. Malaria incidence time series for some parts of Thailand and Indonesia are used to demonstrate that malaria incidences are reasonably well modeled with generalized linear models and artificial

  10. Assessing Wildlife Habitat And Range Utilization in Arizona Using Satellite Data

    NASA Astrophysics Data System (ADS)

    Hutchinson, C. F.; Marsh, S. E.; Krausman, P. R.; Enns, R. M.; Howery, L. D.; Trobia, E.; Wallace, C. S.; Walker, J. J.; Mauz, K.; Boyd, H.; Salazar, H.

    2001-05-01

    Since their reintroduction in 1914, elk (Cervus elaphus) have grown to be a major issue in the western United States. Most land is controlled by federal or state agencies, but individual ranchers have agreements that permit them to graze cattle on much of this land. Elk often compete with cattle for forage, and damage infrastructure (i.e. fences, watering points, and crops). Conversely, environmentalists and hunters also have an interest in the management of elk populations. As a result, consequence of these conflicting interests, there is little agreement about the size of the elk population or the nature, location, and timing of conflicts that elk might cause. This study was intended to provide information that might help managers understand the distribution of elk in Arizona as a consequence of seasonal variation and in response to extreme climatic events (i.e. El Niño and La Niña). The first task involved modeling elk populations over time. There are no long term or large-scale studies of elk movements through continuous observation (i.e. radiocollars). A technique for modeling elk population has been developed that is based on harvest data, gender ratios, and estimates of male mortality. This provided estimates of elk populations for individual game management units (areas for which harvest is reported and within which elk are managed by the Arizona Game and Fish Department). The second task involved the use of satellite data to characterize vegetation responses to seasonal and interannual climate variation among vegetation associations within game management units. This involved the use of NOAA Advanced Very High Resolution Radiometer (AVHRR) time series data to describe temporal vegetation behavior, Landsat and Ikonos data to describe spatial vegetation distribution in conjunction with U.S. Forest Service vegetation maps. Elk population estimates were correlated with satellite-derived vegetation measures by vegetation association through time. The patterns

  11. Forecasting distributions of large federal-lands fires utilizing satellite and gridded weather information

    USGS Publications Warehouse

    Preisler, H.K.; Burgan, R.E.; Eidenshink, J.C.; Klaver, Jacqueline M.; Klaver, R.W.

    2009-01-01

    The current study presents a statistical model for assessing the skill of fire danger indices and for forecasting the distribution of the expected numbers of large fires over a given region and for the upcoming week. The procedure permits development of daily maps that forecast, for the forthcoming week and within federal lands, percentiles of the distributions of (i) number of ignitions; (ii) number of fires above a given size; (iii) conditional probabilities of fires greater than a specified size, given ignition. As an illustration, we used the methods to study the skill of the Fire Potential Index an index that incorporates satellite and surface observations to map fire potential at a national scale in forecasting distributions of large fires. ?? 2009 IAWF.

  12. Technological utilization of space with special regard to navigation satellite systems

    NASA Astrophysics Data System (ADS)

    Stiller, A. H.

    With financial support from the German Minister of Research and Technology (BMFT) two German companies have developed two GPS-C/A-Code-receivers for different applications with low weight and small volume. The measured results of positions in connection with the ABS of a car (Anti lock braking system) and in Diff.-GPS-mode are very satisfying and in the range of 15 and/or 3 meters. Both receivers worked quite well and both companies have demonstrated their capability to meet our high exspectations. Unfortunately the GPS-satellite to be launched are behind schedule, therefore the two German companies cannot sell their products and if the GPS-system will be completed in the year 1991 other technologies with smaller and cheaper receivers will be on the market.

  13. A Case Study Examining Egypt, Nigeria, and Venezuela and their Flaring Behavior Utilizing VIIRS Satellite Data

    NASA Astrophysics Data System (ADS)

    Englander, J. G.; Austin, A. T.; Brandt, A. R.

    2016-12-01

    The need to quantify flaring by oil and gas fields is receiving more scrutiny, as there has been scientific and regulatory interest in quantifying the greenhouse gas (GHG) impact of oil and gas production. The National Oceanic and Atmospheric Administration (NOAA) has developed a method to track flaring activity using a Visible Infrared Imaging Radiometer Suite (VIIRS) satellite.[1] This reports data on the average size, power, and light intensity of each flare. However, outside of some small studies, the flaring intensity has generally been estimated at the country level.[2]While informative, country-level assessments cannot provide guidance about the sustainability of particular crude streams or products produced. In this work we generate detailed oil-field-level flaring intensities for a number of global oilfield operations. We do this by merging the VIIRS dataset with global oilfield atlases and other spatial data sources. Joining these datasets together with production data allows us to provide better estimates for the GHG intensity of flaring at the field level for these countries.[3]First, we compute flaring intensities at the field level for 75 global oil fields representing approximately 25% of global production. In addition, we examine in detail three oil producing countries known to have high rates of flaring: Egypt, Nigeria, and Venezuela. For these countries we compute the flaring rate for all fields in the country and explore within-and between-country variation. The countries' fields will be analyzed to determine the correlation of flare activity to a certain field type, crude type, region, or production method. [1] Cao, C. "Visible Infrared Imaging Radiometer Suite (VIIRS)." NOAA NPP VIIRS. NOAA, 2013. Web. 30 July 2016. [2] Elvidge, C. D. et al., "A Fifteen Year Record of Global Natural Gas Flaring Derived from Satellite Data," Energies, vol. 2, no. 3, pp. 595-622, Aug. 2009. [3] World Energy Atlas. 6th ed. London: Petroleum Economist, 2011. Print.

  14. Direct Spectrum Division Transmission for Highly Efficient Frequency Utilization in Satellite Communications

    NASA Astrophysics Data System (ADS)

    Abe, Jun-Ichi; Yamashita, Fumihiro; Nakahira, Katsuya; Kobayashi, Kiyoshi

    This paper proposes Direct Spectrum Division Transmission with spectrum editing technique. The transmitter divides the single carrier modulated signal into multiple “sub-spectra” in the frequency domain and arranges each sub-spectrum so as to more fully utilize the unused frequency resources. In the receiver, the divided sub-spectra are combined in the frequency domain and demodulated. By editing the divided spectrum in the frequency domain, the total bandwidth occupied by the multiple “sub-spectra” is less than that of the modulated signal. The proposed technique allows the unused frequency resources scattered across the bands to be better utilized. Simulations show that the proposed technique makes the bit error rate negligible.

  15. A gradient model of vegetation and climate utilizing NOAA satellite imagery. Phase 1: Texas transect

    NASA Technical Reports Server (NTRS)

    Greegor, D. H.; Norwine, J.

    1981-01-01

    A new experimental climatological model/variable termed the sponge, a measure of moisture availability based on daily temperature maxima and minima and precipitation, is tested for potential biogeographic, ecological, and agro-climatological applications. Results, depicted in tabular and graphic from, suggest that, as a generalized climatic index, sponge's simplicity and sensitivity make particularly appropriate for trans-regional biogeographic studies (e.g., large-area and global vegetation monitoring). The feasibility of utilizing NOAA/AVHRR data for vegetation classification was investigated and a vegetation gradient model that utilizes sponge, and AVHRR pixel data (channels 1 and 2) were obtained for 12 locations. The normalized difference values for the AVHRR data when plotted against vegetation characteristics (biomass, net productivity, leaf area) and sponge values suggest that a multivariate gradient model incorporating AVHRR and sponge data may indeed be useful in global vegetation stratification and monitoring.

  16. A gradient model of vegetation and climate utilizing NOAA satellite imagery. Phase 1: Texas transect

    NASA Technical Reports Server (NTRS)

    Greegor, D. H.; Norwine, J.

    1981-01-01

    A new experimental climatological model/variable termed the sponge, a measure of moisture availability based on daily temperature maxima and minima and precipitation, is tested for potential biogeographic, ecological, and agro-climatological applications. Results, depicted in tabular and graphic from, suggest that, as a generalized climatic index, sponge's simplicity and sensitivity make particularly appropriate for trans-regional biogeographic studies (e.g., large-area and global vegetation monitoring). The feasibility of utilizing NOAA/AVHRR data for vegetation classification was investigated and a vegetation gradient model that utilizes sponge, and AVHRR pixel data (channels 1 and 2) were obtained for 12 locations. The normalized difference values for the AVHRR data when plotted against vegetation characteristics (biomass, net productivity, leaf area) and sponge values suggest that a multivariate gradient model incorporating AVHRR and sponge data may indeed be useful in global vegetation stratification and monitoring.

  17. A gradient model of vegetation and climate utilizing NOAA satellite imagery. Phase 1: Texas transect

    NASA Technical Reports Server (NTRS)

    Greegor, D.; Norwine, J. (Principal Investigator)

    1981-01-01

    A climatological model/variable termed the sponge (a measure of moisture availability based on daily temperature maxima and minima, and precipitation) was tested for potential biogeograhic, ecological, and agro-climatological applications. Results, depicted in tabular and graphic form, suggest that, as generalized climatic index, sponge is particularly appropriate for large-area and global vegetation monitoring. The feasibility of utilizing NOAA/AVHRR data for vegetation classification was investigated and a vegetation gradient model that utilizes sponge and AVHRR data was initiated. Along an east-west Texas gradient, vegetation, sponge, and AVHRR pixel data (channels 1 and 2) were obtained for 12 locations. The normalized difference values for the AVHRR data when plotted against vegetation characteristics (biomass, net productivity, leaf area) and sponge values along the Texas gradient suggest that a multivariate gradient model incorporating AVHRR and sponge data may indeed be useful in global vegetation stratification and monitoring.

  18. Utility of Slepian basis functions for modeling near-surface and satellite magnetic anomalies of the Australian lithosphere

    NASA Astrophysics Data System (ADS)

    Kim, Hyung Rae; von Frese, Ralph R. B.

    2017-04-01

    The utility of frequency- and space-limited spherical harmonic Slepian basis functions for magnetic anomaly modeling over restricted spherical patches of the Earth was investigated using combined near-surface scalar and CHAMP satellite vector observations from Australia and adjacent marine areas. In particular, Slepian spherical harmonic models up to degree 360 were studied for modeling anomaly features of 1° ( 111 km) and longer over a 25°-radius cap centered on Australia. Relative to the roughly 130,000 coefficients required for global spherical harmonic modeling, less than 5% of this number of coefficients is sufficient for effective localized Slepian modeling. Slepian coefficients have maximum power over the spherical cap and may be exploited for estimating the magnetic anomaly vectors and gradients to all orders within the working precision of the observations. The Earth cap modeled by Slepian coefficients is also more efficient in accommodating local crustal constraints from drilling and other geological and geophysical studies for interpreting the associated magnetic anomaly data registered in spherical coordinates. In general, Slepian spherical harmonic modeling is well suited for combining spectrally diverse compilations of near-surface and satellite magnetic observations over any spatially restricted spherical cap of the Earth or other planetary body.[Figure not available: see fulltext.

  19. Cerebral glucose utilization and blood flow in Huntington's Disease (HD)

    SciTech Connect

    Phelps, M.E.; Mazziotta, J.C.; Wapenski, J.; Riege, W.; Baxter, L.R.

    1985-05-01

    Previous studies in the authors' Laboratory have been carried out on 13 patients symptomatic of HD (SHD) and 15 asymptomatic at-risk for HD (ARHD) with a ECAT II and identification of changes in caudate metabolism using an index technique. The authors report now studies of additional 28 subjects (11 SHD, 17 ARHD) studied drug free and compared to age/sex matched controls using the higher resolution NeuroECAT, FDG for glucose utilization (LCMRGlc) and 0-15 water for cerebral blood flow (CBF). Patients had neurological, psychiatric-tests, x-ray CT and were video taped to determine type, timing and amount of choreathetic movements during study. In SHD (disease duration 4.9 +- 2.7 yrs), significant decreases (30%) in LCMRGlc were found in striatum (SHD=19.3 +- 7.7, controls = 29.9 +- 5.8 ..mu.. moles/min/100g) despite no to moderate caudate atrophy on x-ray CT. Hemisphere and cortical CMRGlc were not significantly decreased. There was a significant correlation between disease duration and ratio of caudate to putamen (Cd/Put). Pattern of LCMRGlc and CBF matched in SHD. The caudate to hemisphere LCMRGlc ratio was not different between ARHD and controls except variance was about 4 times greater for ARHD (ARHD=1.21 +- 0.15, controls = 1.28 +- 0.04) indicating presence of subpopulations in ARHD group. Four ARHD subjects had a ratio of 1 Std. Dev. from mean of SHD (no normals had values in this range). The 2 ARHD subjects with lowest caudate LCMRGlc had Cd/Put ratios > 2 Std. Dev. from controls. Results show 1) LCMRGlc abnormalities in all SHD patients and subpopulations in ARHD, 2) metabolic alterations appear to begin in caudate and spread to putamen and that a Cd/Put value of 0.7 should be found at start of symptoms, and 3) cortex and thalamus are relatively spared in ARHD and early SHD.

  20. Utility of Satellite Data to monitor drought and floods in India

    NASA Astrophysics Data System (ADS)

    Mishra, V.

    2015-12-01

    Extreme hydrologic events such as droughts and floods pose tremendous pressure on society. The damage due to extreme events has increased during the recent decades and it may increase even further under the projected future climate. Real time monitoring of hydrologic extremes is essential to minimize losses to society and infrastructure. However, in many areas, where gauge based observations are not available in timely manner, real-time monitoring of droughts and floods has been challenging. In the absence of in-situ gauge based observations, satellite data from the various platform may provide an useful information for the real-time monitoring. Using the precipitation data from the Tropical Rainfall Measurement Mission (TRMM) a real-time monitor that updates on daily basis was developed for India. The hydrologic variables (soil moisture, runoff, and Evapotranspiration) were simulated using the Variable Infiltration Capacity (VIC) model. The real-time monitor was successfully evaluated for the drought and flood monitoring in India. The monitor provides soil moisture and total runoff conditions at a high resolution. Moreover, the monitor can provide a valuable information on daily streamflow monitoring at the selected gauge stations in India.

  1. From on High: Utilizing Multi-Temporal Atmospheric and Synthetic Aperture Radar Satellites for Land Management Decisions

    NASA Astrophysics Data System (ADS)

    Hall, M.

    2016-12-01

    The Black Rock Field Office (BRFO) of the Bureau of Land Management manages nearly 2 million acres of public land in NW Nevada. Approximately 1.2 million acres area a National Conservation Area (NCA), and over 700,000 acres are formally designated Wilderness Areas. While imagery from Landsat and MODIS assist in monitoring and making land management decisions, multi-temporal data from atmospheric monitoring and synthetic aperture radar (SAR) satellites are also utilized. The Burning Man Festival since 2007 creates a temporary city of 50,000 to 70,000 people in the NCA. Public concern is being expressed over the event's physical and greenhouse gas footprints. Sub-set L2 and L3 CO2 data were obtained from the ACOS, AQUA (AIRS platform) and OCO-2 satellites. These data sets cover both daily and monthly CO2 concentrations between 2007 and 2015. Each data set was analyzed separately using Bayesian time series methods. While there were statistically significant changes in the CO2concentration in a calendar year, none of the increases coincided with the Burning Man Festival. The ALOS-PALSAR and Sentinel-1 SAR data archives have also been utilized. Interferograms, false-color composites (FCC) of coherence images, and FCC of the processed backscattered images are all useful in monitoring surface changes. Case study summaries will illustrate the seasonal changes at critical riparian areas in the NCA; the post-event recovery of the Burning Man Festival footprint; dune formation on the Black Rock playa, and landscape changes associated with open-pit mining in the BRFO.

  2. Utilization of telemedicine by heart disease patients following hospitalization.

    PubMed

    Morguet, Andreas J; Kühnelt, Paul; Kallel, Antje; Rauch, Ursula; Schultheiss, Heinz-Peter

    2008-01-01

    NYHA class III and IV chronic heart failure has been established as a potential indication for telemedical care and monitoring already. We conducted a prospective study to assess the utilization of telemedical services by cardiac patients in order to identify further indications. A total of 540 patients (mean age 59 years) with various heart diseases participated for at least 30 days in a home-based telemedicine service programme. The two primary outcome measures were the rates of symptom-driven telephone calls (A) and ECG transmissions (B) per patient-year. The total follow-up was 68,649 days, with a median of 93 days. Symptomatic patients placed 713 calls and transmitted 221 ECGs. Poisson regression analysis with subset selection yielded four significant (P < 0.05) independent positive predictors of the use of the telemedicine service: (1) recent repeat (at least one previous) percutaneous coronary intervention (A, P = 0.010; B, P = 0.001); (2) recent cardioversion for atrial fibrillation or flutter (A, P < 0.0001; B, P < 0.0001); (3) ejection fraction (A, P = 0.012; B, P > 0.05); and (4) reciprocal of age (A, P < 0.0001; B, P > 0.05). These data suggest that telemedicine may benefit patients following repeat percutaneous coronary intervention or cardioversion for atrial fibrillation. Since patients availed themselves of telemedicine service less with deteriorating ejection fraction and increasing age, individuals with chronic heart failure will need dedicated programmes, especially when they are older.

  3. Intestinal nitrogen recycling and utilization in health and disease.

    PubMed

    Bergen, Werner G; Wu, Guoyao

    2009-05-01

    The role of intestinal microflora in digestive and metabolic processes has received increasing attention from researchers and clinicians. Both enterocytes and small intestine luminal microorganisms can degrade peptides and amino acids (AA). Further, enterocytes can utilize ammonia via glutamate, glutamine, citrulline, and urea synthesis, whereas luminal microbes will deaminate AA, hydrolyze luminal urea, and recycle this ammonia by synthesis of new microbial cells. Although, undoubtedly, some indispensable AA may arise from N cycling and microbial synthesis in the intestinal lumen, the actual net impact on protein nutrition status appears to be limited in humans and animals. Moreover, potential contributions of the recycled N as colonic luminal microbial proteins to AA in blood depend on colonic protein digestion and AA absorption. Finally, new evidence indicates that gut microbial metabolism may be enhanced by prebiotics and probiotics, with the prospects of new treatment paradigms for eliminating undesirable secondary N metabolites and ameliorating complications in whole-body N metabolism under the conditions of intestinal stress, liver disease, and kidney failure.

  4. Molecular diversity of the DNA-beta satellites associated with tomato leaf curl disease in India.

    PubMed

    Sivalingam, P N; Malathi, V G; Varma, A

    2010-05-01

    DNA-beta satellites, referred to here as betasatellites, were found associated with tomato leaf curl disease (ToLCD) in India. The size of eight betasatellites isolated from different geographical locations in India varied from 1353 to 1424 nt; these molecules had an ORF beta C1, an adenine-rich region, and a satellite conserved region. Their nucleotide sequence identity varied from 45 to 93%. In phylogenetic analysis, these betasatellites grouped according to their geographic locations rather than the host species. Two new betasatellites, tomato leaf curl Bangalore betasatellite and tomato leaf curl Maharashtra betasatellite, were identified.

  5. Utilization of VAS satellite data in the initialization of an oceanic-cyclogenesis simulation

    NASA Technical Reports Server (NTRS)

    Douglas, Sharon G.; Warner, Thomas T.

    1986-01-01

    A series of experiments was performed to test various method of incorporating Visible Infrared Spin Scan Radiometer Atmospheric Sounder (VAS)-sounding data into the initial conditions of the Penn State University/National Center for Atmospheric mesoscale model. The VAS data for this ocean-cyclogenesis case consist of 110 irregularly distributed temperature and humidity soundings located over the North Pacific Ocean and apply at approximately 1200 GMT 10 November 1981. Various methods of utilizing VAS data in the initial condition of a mesoscale model were evaluated.

  6. Registration of satellite imagery utilizing the low-low components of the wavelet transform

    NASA Astrophysics Data System (ADS)

    Kaymaz, Emre; Lerner, Bao-Ting; Campbell, William J.; Le Moigne, Jacqueline; Pierce, John F.

    1997-02-01

    The need for fast, accurate, and reliable image registration techniques is increasing primarily due to the large amount of remote sensing data which will be generated by future Earth and space missions and the diversity of such data in temporal, spatial and spectral components. Registration of the remote sensing imagery is one of the most important steps in view of further processing and interpretation of such data since the information fusion from multiple sensors start with the registration of the data. Traditional approaches to image registration require substantial human involvement in the selection and matching of the ground control points in the reference and input data sets. Considering the dramatic increase that is predicted in the volume of remote sensing data that will be collected during future missions, it is imperative that fully automatic registration algorithms be utilized. We present a three-step approach to automatic registration of remote sensing imagery. The first step involves the wavelet decomposition of the reference and input images to be registered. In the second step, we extract domain independent features to be used as the control points from the low-low components of the wavelet decompositions of the reference and input images employing the Lerner algebraic edge detector (LAED) and the Sobel edge detector. Finally, we utilize the maxima of the low-low wavelet coefficients preprocessed by the edge detectors and an exclusive-or based similarity metric to compute the transformation function. We illustrate the effectiveness of the proposed registration method on a Landsat thematic mapper image of the Pacific Northwest, and show that the performance of the LAED is superior to that of the Sobel edge detector.

  7. Clinical utility of celiac disease associated HLA testing

    PubMed Central

    Pallav, Kumar; Kabbani, Toufic; Tariq, Sohaib; Vanga, Rohini; Kelly, Ciaran P.; Leffler, Daniel A.

    2014-01-01

    Background Negative predictive value (NPV) of Celiac Disease (CD) related human leukocyte antigens (HLA) DQ2 and DQ8 approaches 100% in individual patients. However, studies evaluating its exclusionary utility in patient groups are lacking. Aim We aim to assess the performance of HLA testing when applied to patient groups with varying characteristics and propose evidence-based recommendations for its clinical use. Methods Demographic and clinical information was recorded in patients undergoing HLA testing. Using predetermined criteria, patients were classified as CD, Non CD or indeterminate. Diagnostic yield of HLA testing was defined as the percentage of patients in whom CD could be excluded based on negative HLA test. Results 256 patients underwent testing for CD related HLA DQ2 and DQ8. 102 (100 Non CD, 2 CD) patients tested HLA negative for a 98% NPV and 39% diagnostic yield. Diagnostic yield was highest (60%) in patients with intraepithelial lymphocytosis plus normal IgA tissue transglutaminase antibody (IgA-tTG) and lowest in patients with positive IgA-tTG plus villous atrophy (0%). CD was diagnosed in 2 HLA negative patients, who carried half of DQ2.5 trans genotype. Conclusions Diagnostic yield of CD related HLA testing varies widely depending on clinical indication. HLA testing is a practical and valuable test for most patients in whom initial evaluation for CD is inconclusive. A negative HLA result usually obviates the need for further celiac testing including endoscopy and gluten challenge. Rarely, in patients reported as HLA negative, half of HLA DQ2.5 (cis or trans) is sufficient for development of CD. PMID:24705698

  8. Objective Operational Utilization of Satellite Microwave Scatterometer Observations of Tropical Cyclones

    NASA Technical Reports Server (NTRS)

    Cardone, Vincent J.; Cox, Andrew T.

    2000-01-01

    This study has demonstrated that high-resolution scatterometer measurements in tropical cyclones and other high-marine surface wind regimes may be retrieved accurately for wind speeds up to about 35 mls (1-hour average at 10 m) when the scatterometer data are processed through a revised geophysical model function, and a spatial adaptive algorithm is applied which utilizes the fact that wind direction is so tightly constrained in tile inner core of severe marine storms that wind direction may be prescribed from conventional data. This potential is demonstrated through case studies with NSCAT data in a severe West Pacific Typhoon (Violet, 1996) and an intense North Atlantic hurricane (Lili, 1996). However, operational scatterometer winds from NSCAT and QuickScat in hurricanes and severe winter storms are biased low in winds above 25 m/s. We have developed an inverse model to specify the entire surface wind field about a tropical cyclone from operational QuickScat scatterometer measurements within 150 nm of a storm center with the restriction that only wind speeds up to 20 m/s are used until improved model function are introduced. The inverse model is used to specify the wind field over the entire life-cycle of Hurricane Floyd (1999) for use to drive an ocean wave model. The wind field compares very favorably with wind fields developed from the copious aircraft flight level winds obtained in this storm.

  9. Utilization of Satellite Dish Technology and its Application in Taping PeachStar Programming: A Survey of Library Media Specialists.

    ERIC Educational Resources Information Center

    Razza, Betsy L.

    Through lottery funding, all public schools in Georgia received satellite dish equipment. This study is an assessment of the use of the satellite dish equipment by library media specialists in the DeKalb County School System for taping PeachStar (the satellite channel of Georgia Public Broadcasting) programming. The purpose was four-fold: (1) to…

  10. Global Monitoring of Precipitation on Monthly and Shorter Time Scales Utilizing Low-Orbit and Geosynchronous Satellite Observations

    NASA Technical Reports Server (NTRS)

    Adler, Robert; Curtis, Scott; Huffman, George; Bolvin, David; Nelkin, Eric

    1999-01-01

    A satellite-based system to monitor global precipitation on monthly and shorter time scales is described. The monitoring system is based primarily on the Global Precipitation Climatology Project (GPCP) global, monthly, 2.5 degree by 2.5 degree latitude-longitude product which utilizes precipitation estimates from low-orbit microwave sensors (SSM/I) and geosynchronous IR sensors and raingauge information over land. The low-orbit microwave estimates are used to adjust or correct the geosynchronous IR estimates, thereby maximizing the utility of the more physically-based microwave estimates and the finer time sampling of the geosynchronous observations. Information from raingauges is blended into the analyses over land. This globally complete, monthly product is available from January 1986 to the present, with an extension back to January 1979 underway using non-SSM/I data. The monthly GPCP merged data product described in the previous paragraph is available a few (2-4) months after the end of the month. An analysis based solely on low-orbit microwave (SSM/1) data and the Goddard Profiling (GPROF) algorithm is used to bring the global monitoring up to real time. Anomalies from climatological means are produced from both the GPCP and GPROF fields to monitor the evolution of global precipitation, including the calculation of ENSO precipitation indices for real-time (five- day running means) climate monitoring and comparison with previous ENSO anomalies. The long-term climatology of the global precipitation field and the time and space variations thereof will be discussed, including the variations associated with the 1997- 1998 ENSO. The GPCP fields will also be compared to analyses based on the recently launched Tropical Rain Measuring Mission (TRMM). On an even shorter time scale, a new daily, 1 degree x 1 degree latitude-longitude global analysis has been developed starting in January 1997 utilizing low-orbit microwave and geosynchronous IR information using a similar

  11. Global Monitoring of Precipitation on Monthly and Shorter Time Scales Utilizing Low-Orbit and Geosynchronous Satellite Observations

    NASA Technical Reports Server (NTRS)

    Adler, Robert; Curtis, Scott; Huffman, George; Bolvin, David; Nelkin, Eric

    1999-01-01

    A satellite-based system to monitor global precipitation on monthly and shorter time scales is described. The monitoring system is based primarily on the Global Precipitation Climatology Project (GPCP) global, monthly, 2.5 degree by 2.5 degree latitude-longitude product which utilizes precipitation estimates from low-orbit microwave sensors (SSM/I) and geosynchronous IR sensors and raingauge information over land. The low-orbit microwave estimates are used to adjust or correct the geosynchronous IR estimates, thereby maximizing the utility of the more physically-based microwave estimates and the finer time sampling of the geosynchronous observations. Information from raingauges is blended into the analyses over land. This globally complete, monthly product is available from January 1986 to the present, with an extension back to January 1979 underway using non-SSM/I data. The monthly GPCP merged data product described in the previous paragraph is available a few (2-4) months after the end of the month. An analysis based solely on low-orbit microwave (SSM/1) data and the Goddard Profiling (GPROF) algorithm is used to bring the global monitoring up to real time. Anomalies from climatological means are produced from both the GPCP and GPROF fields to monitor the evolution of global precipitation, including the calculation of ENSO precipitation indices for real-time (five- day running means) climate monitoring and comparison with previous ENSO anomalies. The long-term climatology of the global precipitation field and the time and space variations thereof will be discussed, including the variations associated with the 1997- 1998 ENSO. The GPCP fields will also be compared to analyses based on the recently launched Tropical Rain Measuring Mission (TRMM). On an even shorter time scale, a new daily, 1 degree x 1 degree latitude-longitude global analysis has been developed starting in January 1997 utilizing low-orbit microwave and geosynchronous IR information using a similar

  12. The Implications of Healthcare Utilization of Diabetes Disease Management

    DTIC Science & Technology

    2008-06-24

    regression indicate that the overall model significantly predicts of outpatient utilization, R:=.048. R2«j«s.045, F= 19.047. P<.000. This study demonstrates... Regression results indicate that the overall model significantly predicts of outpatient utilization, R2=048, R2adJ=.045, F=19.047, P<.00(f, see...manage patients with diabetes’.’" Standard regression was conducted to determine the accuracy of the independent (HbAlc Testing 2005. 2006 and 2007

  13. Shifting the emphasis: From cost models to satellite utility or revenue models. The case for a value-centric mindset in space system design

    NASA Astrophysics Data System (ADS)

    Saleh, Joseph H.; Jordan, Nicole C.; Newman, Dava J.

    2007-11-01

    Cost models are pervasive throughout the aerospace industry. Almost every engineer or program manager in this industry is familiar with cost models or cost estimate relationships (CER), and has at some point in his or her career performed cost analyses for a system or a subsystem. This situation is the laudable result of the emphasis over the last two decades on financial discipline in the design of complex engineering systems. Unfortunately, while cost models are pervasive throughout the aerospace industry, revenue models or utility models on the other hand are quasi-inexistent. In this paper, we argue that while the proliferation of spacecraft cost models is laudable, the absence of interest in satellite utility or revenue models is deplorable. We contend that this situation carries a number of drawbacks. For example, the situation perhaps conveys the false impression that satellites are either cost sinks, or expensive artifacts whose value or utility profile over their design lifetime is difficult to quantify and does not warrant efforts to do so. More importantly, we argue that the absence of quantitative revenue models (in the case of commercial systems) or utility models (in the case of scientific or military systems) makes it difficult to build the case for such systems to policy-makers or decision-makers, especially in the light in their exorbitant costs. Furthermore, we show that the specification and selection of a system design lifetime will always have weak arguments fraught with subjectivity in the absence of quantitative revenue or utility models. We make the case that satellites, like other complex engineering systems, should be viewed as "value-delivery artifacts." Finally, we propose a roadmap for developing a spacecraft utility model in the case of a GEO communications satellite.

  14. Statistical assessment and hydrological utility of the latest multi-satellite precipitation analysis IMERG in Ganjiang River basin

    NASA Astrophysics Data System (ADS)

    Li, Na; Tang, Guoqiang; Zhao, Ping; Hong, Yang; Gou, Yabin; Yang, Kai

    2017-01-01

    This study aims to statistically and hydrologically assess the hydrological utility of the latest Integrated Multi-satellitE Retrievals from Global Precipitation Measurement (IMERG) multi-satellite constellation over the mid-latitude Ganjiang River basin in China. The investigations are conducted at hourly and 0.1° resolutions throughout the rainy season from March 12 to September 30, 2014. Two high-quality quantitative precipitation estimation (QPE) datasets, i.e., a gauge-corrected radar mosaic QPE product (RQPE) and a highly dense network of 1200 rain gauges, are used as the reference. For the implementation of the study, first, we compare IMERG product and RQPE with rain gauge-interpolated data, respectively. The results indicate that both remote sensing products can estimate precipitation fairly well over the basin, while RQPE significantly outperforms IMERG product in almost all the studied cases. The correlation coefficients of RQPE (CC = 0.98 and CC = 0.67) are much higher than those of IMERG product (CC = 0.80 and CC = 0.33) at basin and grid scales, respectively. Then, the hydrological assessment is conducted with the Coupled Routing and Excess Storage (CREST) model under multiple parameterization scenarios, in which the model is calibrated using the rain gauge-interpolated data, RQPE, and IMERG products respectively. During the calibration period (from March 12 to May 31), the simulated streamflow based on rain gauge-interpolated data shows the highest Nash-Sutcliffe coefficient efficiency (NSCE) value (0.92), closely followed by the RQPE (NSCE = 0.84), while IMERG product performs barely acceptable (NSCE = 0.56). During the validation period (from June 1 to September 30), the three rainfall datasets are used to force the CREST model based on all the three calibrated parameter sets (i.e., nine combinations in total). RQPE outperforms rain gauge-interpolated data and IMERG product in all validation scenarios, possibly due to its advantageous capability

  15. Utility of colour Doppler sonography in patients with Graves' disease.

    PubMed

    Kumar, K V S Hari; Vamsikrishna, P; Verma, A; Muthukrishnan, J; Rayudu, B Ramasubba; Modi, K D

    2009-12-01

    Assessment of thyroid blood flow gives valuable information about underlying functional status. Colour Flow Doppler Sonography (CFDS) is a powerful tool which displays tissue blood flow and vascularity. Colour Flow Doppler Sonography of the thyroid gland in different subsets of patients with Graves' disease was studied to define its role in initial diagnosis and management. Eighty consecutive patients with Graves' disease (both treated and untreated) presented to hospital between August 2007 and February 2008. All patients were evaluated with CFDS of the thyroid for size, vascularity and peak systolic velocity (PSV) of the Inferior Thyroid Artery (ITA). Pertechnate scan and thyroidal autoantibody levels were done in selected cases. The patients were divided into Untreated Graves' disease (n = 31), Graves' disease on treatment but hyperthyroid (n = 26) and euthyroid Graves' disease on therapy (n = 23). Mann-Whitney U-test was used for statistical analysis and a p-value of less than 0.05 was considered significant. Thyroid blood flow, as assessed by PSV of ITA, was significantly higher in untreated Graves' disease than in Graves disease on treatment but hyperthyroid and euthyroid Graves respectively (61.5 +/- 19.5 versus 42.9 +/- 24.7 versus 32.2 +/- 12.9 cm/s, p < 0.05). Parenchymal vascularity of the thyroid gland was higher in hyperthyroid patients than in euthyroid patients irrespective of therapy. In both groups on therapy, the dose of carbimazole correlated with the vascularity of the gland (r = 0.492 versus 0.564, p < 0.05). Colour Flow Doppler Sonography parameters correlated significantly with pertechnate scan results giving comparable sensitivity and specificity. Assessment of thyroid blood flow by CFDS is an effective marker in the initial diagnosis of Graves' disease. Vascularity of the gland can predict long term disease course while on medical therapy.

  16. Monitoring Disease Trends using Hospital Traffic Data from High Resolution Satellite Imagery: A Feasibility Study

    PubMed Central

    Nsoesie, Elaine O.; Butler, Patrick; Ramakrishnan, Naren; Mekaru, Sumiko R.; Brownstein, John S.

    2015-01-01

    Challenges with alternative data sources for disease surveillance include differentiating the signal from the noise, and obtaining information from data constrained settings. For the latter, events such as increases in hospital traffic could serve as early indicators of social disruption resulting from disease. In this study, we evaluate the feasibility of using hospital parking lot traffic data extracted from high-resolution satellite imagery to augment public health disease surveillance in Chile, Argentina and Mexico. We used archived satellite imagery collected from January 2010 to May 2013 and data on the incidence of respiratory virus illnesses from the Pan American Health Organization as a reference. We developed dynamical Elastic Net multivariable linear regression models to estimate the incidence of respiratory virus illnesses using hospital traffic and assessed how to minimize the effects of noise on the models. We noted that predictions based on models fitted using a sample of observations were better. The results were consistent across countries with selected models having reasonably low normalized root-mean-squared errors and high correlations for both the fits and predictions. The observations from this study suggest that if properly procured and combined with other information, this data source could be useful for monitoring disease trends. PMID:25765943

  17. Utilizing a disease management approach to improve ESRD patient outcomes.

    PubMed

    Anand, Shaan; Nissenson, Allen R

    2002-01-01

    In this era of processes and systems to improve quality, disease management is one methodology to improve care delivery and outcomes for patients with chronic kidney disease (CKD). In most disease management systems a senior renal nurse coordinates all aspects of the patient's care and ensures that the prescribed and necessary care is delivered for both CKD-related and comorbid conditions. The nurse also continually monitors outcomes on quality indicators and key performance measures. These outcome data are then aggregated and analyzed, are compared with local and national benchmarks, and drive the continuous quality improvement (CQI) process. Such a system attempts to centralize the currently fragmented care delivery system, continually improve patient outcomes, and conserve scarce economic resources. Early data suggest a disease management approach may improve both the morbidity and mortality of CKD patients.

  18. Association between satellite-based estimates of long-term PM2.5 exposure and coronary artery disease.

    PubMed

    McGuinn, Laura A; Ward-Caviness, Cavin K; Neas, Lucas M; Schneider, Alexandra; Diaz-Sanchez, David; Cascio, Wayne E; Kraus, William E; Hauser, Elizabeth; Dowdy, Elaine; Haynes, Carol; Chudnovsky, Alexandra; Koutrakis, Petros; Devlin, Robert B

    2016-02-01

    Epidemiological studies have identified associations between long-term PM2.5 exposure and cardiovascular events, though most have relied on concentrations from central-site air quality monitors. We utilized a cohort of 5679 patients who had undergone cardiac catheterization at Duke University between 2002-2009 and resided in North Carolina. We used estimates of daily PM2.5 concentrations for North Carolina during the study period based on satellite derived Aerosol Optical Depth (AOD) measurements and PM2.5 concentrations from ground monitors, which were spatially resolved with a 10×10km resolution, matched to each patient's residential address and averaged for the year prior to catheterization. The Coronary Artery Disease (CAD) index was used to measure severity of CAD; scores >23 represent a hemodynamically significant coronary artery lesion in at least one major coronary vessel. Logistic regression modeled odds of having CAD or an MI with each 1μg/m(3) increase in annual average PM2.5, adjusting for sex, race, smoking status and socioeconomic status. In adjusted models, a 1μg/m(3) increase in annual average PM2.5 was associated with an 11.1% relative increase in the odds of significant CAD (95% CI: 4.0-18.6%) and a 14.2% increase in the odds of having a myocardial infarction (MI) within a year prior (95% CI: 3.7-25.8%). Satellite-based estimates of long-term PM2.5 exposure were associated with both coronary artery disease (CAD) and incidence of myocardial infarction (MI) in a cohort of cardiac catheterization patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Clinical utility of sympathetic blockade in cardiovascular disease management.

    PubMed

    Park, Chan Soon; Lee, Hae-Young

    2017-04-01

    A dysregulated sympathetic nervous system is a major factor in the development and progression of cardiovascular disease; thus, understanding the mechanism and function of the sympathetic nervous system and appropriately regulating sympathetic activity to treat various cardiovascular diseases are crucial. Areas covered: This review focused on previous studies in managing hypertension, atrial fibrillation, coronary artery disease, heart failure, and perioperative management with sympathetic blockade. We reviewed both pharmacological and non-pharmacological management. Expert commentary: Chronic sympathetic nervous system activation is related to several cardiovascular diseases mediated by various pathways. Advancement in measuring sympathetic activity makes visualizing noninvasively and evaluating the activation level even in single fibers possible. Evidence suggests that sympathetic blockade still has a role in managing hypertension and controlling the heart rate in atrial fibrillation. For ischemic heart disease, beta-adrenergic receptor antagonists have been considered a milestone drug to control symptoms and prevent long-term adverse effects, although its clinical implication has become less potent in the era of successful revascularization. Owing to pathologic involvement of sympathetic nervous system activation in heart failure progression, sympathetic blockade has proved its value in improving the clinical course of patients with heart failure.

  20. New vegetation type map of India prepared using satellite remote sensing: Comparison with global vegetation maps and utilities

    NASA Astrophysics Data System (ADS)

    Roy, P. S.; Behera, M. D.; Murthy, M. S. R.; Roy, Arijit; Singh, Sarnam; Kushwaha, S. P. S.; Jha, C. S.; Sudhakar, S.; Joshi, P. K.; Reddy, Ch. Sudhakar; Gupta, Stutee; Pujar, Girish; Dutt, C. B. S.; Srivastava, V. K.; Porwal, M. C.; Tripathi, Poonam; Singh, J. S.; Chitale, Vishwas; Skidmore, A. K.; Rajshekhar, G.; Kushwaha, Deepak; Karnatak, Harish; Saran, Sameer; Giriraj, A.; Padalia, Hitendra; Kale, Manish; Nandy, Subrato; Jeganathan, C.; Singh, C. P.; Biradar, C. M.; Pattanaik, Chiranjibi; Singh, D. K.; Devagiri, G. M.; Talukdar, Gautam; Panigrahy, Rabindra K.; Singh, Harnam; Sharma, J. R.; Haridasan, K.; Trivedi, Shivam; Singh, K. P.; Kannan, L.; Daniel, M.; Misra, M. K.; Niphadkar, Madhura; Nagabhatla, Nidhi; Prasad, Nupoor; Tripathi, O. P.; Prasad, P. Rama Chandra; Dash, Pushpa; Qureshi, Qamer; Tripathi, S. K.; Ramesh, B. R.; Gowda, Balakrishnan; Tomar, Sanjay; Romshoo, Shakil; Giriraj, Shilpa; Ravan, Shirish A.; Behera, Soumit Kumar; Paul, Subrato; Das, Ashesh Kumar; Ranganath, B. K.; Singh, T. P.; Sahu, T. R.; Shankar, Uma; Menon, A. R. R.; Srivastava, Gaurav; Neeti; Sharma, Subrat; Mohapatra, U. B.; Peddi, Ashok; Rashid, Humayun; Salroo, Irfan; Krishna, P. Hari; Hajra, P. K.; Vergheese, A. O.; Matin, Shafique; Chaudhary, Swapnil A.; Ghosh, Sonali; Lakshmi, Udaya; Rawat, Deepshikha; Ambastha, Kalpana; Malik, Akhtar H.; Devi, B. S. S.; Gowda, Balakrishna; Sharma, K. C.; Mukharjee, Prashant; Sharma, Ajay; Davidar, Priya; Raju, R. R. Venkata; Katewa, S. S.; Kant, Shashi; Raju, Vatsavaya S.; Uniyal, B. P.; Debnath, Bijan; Rout, D. K.; Thapa, Rajesh; Joseph, Shijo; Chhetri, Pradeep; Ramachandran, Reshma M.

    2015-07-01

    A seamless vegetation type map of India (scale 1: 50,000) prepared using medium-resolution IRS LISS-III images is presented. The map was created using an on-screen visual interpretation technique and has an accuracy of 90%, as assessed using 15,565 ground control points. India has hitherto been using potential vegetation/forest type map prepared by Champion and Seth in 1968. We characterized and mapped further the vegetation type distribution in the country in terms of occurrence and distribution, area occupancy, percentage of protected area (PA) covered by each vegetation type, range of elevation, mean annual temperature and precipitation over the past 100 years. A remote sensing-amenable hierarchical classification scheme that accommodates natural and semi-natural systems was conceptualized, and the natural vegetation was classified into forests, scrub/shrub lands and grasslands on the basis of extent of vegetation cover. We discuss the distribution and potential utility of the vegetation type map in a broad range of ecological, climatic and conservation applications from global, national and local perspectives. We used 15,565 ground control points to assess the accuracy of products available globally (i.e., GlobCover, Holdridge's life zone map and potential natural vegetation (PNV) maps). Hence we recommend that the map prepared herein be used widely. This vegetation type map is the most comprehensive one developed for India so far. It was prepared using 23.5 m seasonal satellite remote sensing data, field samples and information relating to the biogeography, climate and soil. The digital map is now available through a web portal (http://bis.iirs.gov.in).

  1. Simultaneous precision positioning and vibration suppression of an intelligent composite satellite structure utilizing piezoelectric sensors and actuators

    NASA Astrophysics Data System (ADS)

    Doherty, Kathleen Marie

    Adaptive or intelligent structures which have the capability for sensing and responding to their environment promise a novel approach to satisfying the stringent performance requirements of future space missions. This research effort focuses on the development of a smart thruster mount truss structure with precision positioning and active vibration suppression capability for use in a space satellite. The smart thruster mount would utilize piezoelectric sensors and actuators for precision positioning to provide fine tuning of position tolerance for thruster alignment. The same structure may be used for suppressing the vibration that resonates throughout the spacecraft during thruster firing. This vibration renders sensitive optical or measurement equipment non-operational until the disturbance has dissipated. This smart system approach would greatly enhance mission performance by fine tuning attitude control, potentially eliminating the nonoperational period as well as minimizing fuel consumption utilized for position correction. The configuration of the smart thruster mount truss system is that of a modified Stewart platform. Precision positioning of the truss structure is achieved using active members which extend or contract to tilt the upper platform where the thruster is mounted. An inverse kinematic analysis of a modified Stewart platform has been developed and is used to determine the required axial displacement of the active struts for the desired angular tilt of the smart platform. Experimental data is used to verify the precision positioning capabilities of the active struts. This information demonstrates the ability of the active strut to tilt the top of the smart platform by the required angular displacement. Analytical verification of the vibration suppression capabilities of the active struts in the smart composite platform using finite element analysis is presented. A model of an active strut with surface mounted sensors/actuators was used to develop

  2. A Preliminary Study of Psychiatric, Familial, and Medical Characteristics of High Utilizing Sickle Cell Disease Patients

    PubMed Central

    Carroll, C. Patrick; Haywood, Carlton; Hoot, Michelle R.; Lanzkron, Sophie

    2012-01-01

    Objectives To identify demographic, medical, and psychosocial characteristics that distinguished sickle cell disease patients who were frequent utilizers of urgent or emergent care resources from low-utilizing patients. Methods Patients at a large urban comprehensive sickle cell disease treatment center were recruited from clinic or during urgent care visits. Participants who were high utilizers, defined as having more than 4 acute or emergency care visits in the prior 12 months, were compared to patients with more typical utilization patterns on lifetime complications of SCD, family background, psychiatric history, occupational function, coping, depressive symptoms, and personality. Results High utilizers were nearly a decade younger on average; despite this they had a similar lifetime history of SCD complications. High utilizing patients' parents appeared to have greater educational achievement overall. High utilizers reported a nearly three-fold greater prevalence of psychiatric illness in family members than low utilizers. On other measures; including coping strategies, social support, and personality; the two groups were comparable. Discussion The study strengthens emerging evidence that disease severity, familial factors related to greater parental education, and psychiatric illness are important factors in high care utilization in patients with sickle cell disease. PMID:23246997

  3. Utility of different cardiovascular disease prediction models in rheumatoid arthritis

    PubMed Central

    Purcarea, A; Sovaila, S; Udrea, G; Rezus, E; Gheorghe, A; Tiu, C; Stoica, V

    2014-01-01

    Background. Rheumatoid arthritis comes with a 30% higher probability for cardiovascular disease than the general population. Current guidelines advocate for early and aggressive primary prevention and treatment of risk factors in high-risk populations but this excess risk is under-addressed in RA in real life. This is mainly due to difficulties met in the correct risk evaluation. This study aims to underline the differences in results of the main cardiovascular risk screening models in the real life rheumatoid arthritis population. Methods. In a cross-sectional study, patients addressed to a tertiary care center in Romania for an biannual follow-up of rheumatoid arthritis and the ones who were considered free of any cardiovascular disease were assessed for subclinical atherosclerosis. Clinical, biological and carotidal ultrasound evaluations were performed. A number of cardiovascular disease prediction scores were performed and differences between tests were noted in regard to subclinical atherosclerosis as defined by the existence of carotid intima media thickness over 0,9 mm or carotid plaque. Results. In a population of 29 Romanian rheumatoid arthritis patients free of cardiovascular disease, the performance of Framingham Risk Score, HeartSCORE, ARIC cardiovascular disease prediction score, Reynolds Risk Score, PROCAM risk score and Qrisk2 score were compared. All the scores under-diagnosed subclinical atherosclerosis. With an AUROC of 0,792, the SCORE model was the only one that could partially stratify patients in low, intermediate and high-risk categories. The use of the EULAR recommended modifier did not help to reclassify patients. Conclusion. The only score that showed a statistically significant prediction capacity for subclinical atherosclerosis in a Romanian rheumatoid arthritis population was SCORE. The additional calibration or the use of imaging techniques in CVD risk prediction for the intermediate risk category might be warranted. PMID:25713628

  4. Utilization of LAPAN Satellite (TUBSAT, A2, and A3) in supporting Indonesia’s potential as maritime center of the world

    NASA Astrophysics Data System (ADS)

    Julzarika, A.

    2017-01-01

    Indonesia has archipelago area of 2.8 million km2, territorial sea area of 0.4 km2. Indonesia have number of 13.466 islands. Coastline length of Indonesia reached 99.093 km2. Large areas can be monitored using remote sensing technology. Currently, Indonesia have research remote sensing satellites, namely LAPAN TUBSAT, LAPAN A2, LISAT (A3). All of these satellites could be used to monitor Indonesia. These satellites can be used to make the DSM using videogrammetry and depth cue perceptive methods. They also can be used for identification of geobiophysic parameter. Indonesian maritime territory which has sea highway planning can also be monitored using this satellites combination. AIS sensor on LAPAN A2 can be used to identify ships that pass in the territorial waters of Indonesia. It diagonally across the Indonesian region of west to east as much as 14 times a day. At this point it will have detection radius of over 100 km and has the ability to receive signals from maximum of 2000 vessels in the coverage area. Utilization of this satellites is expected to be helpful in supporting the ships cruise monitoring and their support sea highway also in making Indonesia as maritime center of the world.

  5. Techniques for analyzing and utilizing the rain gauges at the NASA White Sands Test Facility. [Tracking and Data Relay Satellite System ground station

    NASA Technical Reports Server (NTRS)

    Kalagher, R. J.

    1973-01-01

    Ten tipping bucket rain gauges have been installed at the NASA WSTF for the purpose of determining rainfall characteristics in this area which may affect the performance of the NASA Tracking and Data Relay Satellite System. A plan is presented for analyzing and utilizing the data which will be obtained during the course of this experiment. Also included is a description of a computer program which has been written to aid in the analysis.

  6. Multispectral imaging utilizing LCTF technology for plant disease detection

    NASA Astrophysics Data System (ADS)

    Tian, Lixun; Liao, Ningfang; Chai, Ali; Tan, Boneng; Cui, Deqi; Wang, Jiajia

    2011-08-01

    The aim of this paper is to pave the way for the establishment of analysis of the lights reflected from the leaf's surface as an analytical method of plant disease. An imaging LCTF spectrometer that covers a visible light with 400-720 nm wavelength bands has been developed. This paper first outlines the structure of imaging LCTF spectrometer, including their operational principles and construction. Next, various spectral images acquired using the LCTF spectrometer in laboratory environment experiments to measure spectral characteristics of rays reflected from cucumber leaves surfaces that are infected by different germs are analyzed. Then, the results of the experiments conducted using the imaging spectrometer are shown, including the analyzed relative radiance of rays reflected from the plants, and spectral images acquired at various wavelengths. These experimental results demonstrate clearly that rays reflected from plant contaminated by different disease germs have different spectral properties.

  7. The utility of information collected by occupational disease surveillance systems.

    PubMed

    Money, A; Carder, M; Hussey, L; Agius, R M

    2015-11-01

    The Health and Occupation Research (THOR) network in the UK and the Republic of Ireland (ROI) is an integrated system of surveillance schemes collecting work-related ill-health (WRIH) data since 1989. In addition to providing information about disease incidence, trends in incidence and the identification of new hazards, THOR also operates an ad hoc data enquiry service enabling interested parties to request information about cases of WRIH reported to THOR. To examine requests for information made to a network of surveillance schemes for WRIH in the UK. Analysis via SPSS of data requests received by THOR between 2002 and 2014. A total of 631 requests were received by THOR between 2002 and 2014. Requests were predominantly submitted by participating THOR physicians (34%) and the main THOR funder-the UK Health & Safety Executive (HSE) (31%). The majority (67%) of requests were for information about work-related respiratory or skin disease with relatively few requests for other diagnoses, such as musculoskeletal or mental ill-health. Requests frequently related to a specific industry and/or occupation (42%) and/or a specific causal agent (58%). Data collected by occupational disease surveillance systems such as THOR are an extremely useful source of information, the use of which extends beyond informing government on disease incidence and trends in incidence. The data collected provide a framework that can assist a wide range of enquirers with clinical diagnoses, identification of suspected causative agents/exposures and to highlight growing risks in particular industrial and occupational sectors. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  8. From scientific understanding to operational utility: New concepts and tools for monitoring space weather effects on satellites

    NASA Astrophysics Data System (ADS)

    Green, J. C.; Rodriguez, J. V.; Denig, W. F.; Redmon, R. J.; Blake, J. B.; Mazur, J. E.; Fennell, J. F.; O'Brien, T. P.; Guild, T. B.; Claudepierre, S. G.; Singer, H. J.; Onsager, T. G.; Wilkinson, D. C.

    2013-12-01

    NOAA space weather sensors have monitored the near Earth space radiation environment for more than three decades providing one of the only long-term records of these energetic particles that can disable satellites and pose a threat to astronauts. These data have demonstrated their value for operations for decades, but they are also invaluable for scientific discovery. Here we describe the development of new NOAA tools for assessing radiation impacts to satellites and astronauts working in space. In particular, we discuss the new system implemented for processing and delivering near real time particle radiation data from the POES/MetOp satellites. We also describe the development of new radiation belt indices from the POES/MetOp data that capture significant global changes in the environment needed for operational decision making. Lastly, we investigate the physical processes responsible for dramatic changes of the inner proton belt region and the potential consequences these new belts may have for satellite operations.

  9. Diagnostic Utility of Auto-Antibodies in Inflammatory Muscle Diseases.

    PubMed

    Allenbach, Y; Benveniste, O

    2015-01-01

    To date, there are four main groups of idiopathic inflammatory myopathies (IIM): polymyositis (PM), dermatomyositis (DM), immune-mediated necrotizing myopathy (IMNM) and sporadic inclusion body myositis; based on clinical presentation and muscle pathology. Nevertheless, important phenotypical differences (either muscular and/or extra-muscular manifestations) within a group persist. In recent years, the titration of different myositis-specific (or associated) auto-antibodies as a diagnostic tool has increased. This is an important step forward since it may facilitate, at a viable cost, the differential diagnosis between IIM and other myopathies. We have now routine access to assays for the detection of different antibodies. For example, IMNM are related to the presence of anti-SRP or anti-HMGCR. PM is associated with anti-synthetase antibodies (anti-Jo-1, PL-7, PL-12, OJ, and EJ) and DM with anti-Mi-2, anti-SAE, anti-TIF-1-γ and anti-NXP2 (both associated with cancer) or anti-MDA5 antibodies (associated with interstitial lung disease). Today, over 30 myositis specific and associated antibodies have been characterised, and all groups of myositis may present one of those auto-antibodies. Most of them allow identification of homogenous patient groups, more precisely than the classical international classifications of myositis. This implies that classification criteria could be modified accordingly, since these auto-antibodies delineate groups of patients suffering from myositis with consistent clinical phenotype (muscular and extra-muscular manifestations), common prognostic (cancer association, presence of interstitial lung disease, mortality and risk of relapse) and treatment responses. Nevertheless, since numerous auto-antibodies have been recently characterised, the exact prevalence of myositis specific antibodies remains to be documented, and research of new auto-antibodies in the remaining seronegative group is still needed.

  10. Health Care Utilization among Migrant Latino Farmworkers: The Case of Skin Disease

    ERIC Educational Resources Information Center

    Feldman, Steven R.; Vallejos, Quirina M.; Quandt, Sara A.; Fleischer, Alan B., Jr.; Schulz, Mark R.; Verma, Amit; Arcury, Thomas A.

    2009-01-01

    Context: Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. Purpose: Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods: Three hundred and four migrant…

  11. Health Care Utilization among Migrant Latino Farmworkers: The Case of Skin Disease

    ERIC Educational Resources Information Center

    Feldman, Steven R.; Vallejos, Quirina M.; Quandt, Sara A.; Fleischer, Alan B., Jr.; Schulz, Mark R.; Verma, Amit; Arcury, Thomas A.

    2009-01-01

    Context: Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. Purpose: Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods: Three hundred and four migrant…

  12. Low Profile and Low Cost Antenna Technology for Satellite TV Reception on Sports Utility Vehicles (SUV) for the US Market

    NASA Astrophysics Data System (ADS)

    Vazquez, F. Javier; Pearson, Robert A.; Driscoll, Barry G.

    2003-07-01

    A low profile scanning antenna for reception of satellite TV has been developed for the US market compatible with existing DBS Ku band satellite infrastructure. This antenna technology does not require active RF components and it is inherently low cost (in the order of a few hundred dollars even in moderate production volumes). The antenna is able to scan a circularly polarised beam in the range 20 to 69 degrees, covering three DBS satellites in the US including some margin for vehicle tilt. An antenna demonstrator of 115 mm height, including the radome and tracking electronics has been built and measured. Live tests were performed in the US during 2002 to determine realistic link margins and antenna specifications. A product development is currently being undertaken to turn the demonstrator unit into a product for the US market by the end of 2003.

  13. Using Satellite Images of Environmental Changes to Predict Infectious Disease Outbreaks

    PubMed Central

    Colwell, Rita R.; Rose, Joan B.; Morse, Stephen S.; Rogers, David J.; Yates, Terry L.

    2009-01-01

    Recent events clearly illustrate a continued vulnerability of large populations to infectious diseases, which is related to our changing human-constructed and natural environments. A single person with multidrug-resistant tuberculosis in 2007 provided a wake-up call to the United States and global public health infrastructure, as the health professionals and the public realized that today’s ease of airline travel can potentially expose hundreds of persons to an untreatable disease associated with an infectious agent. Ease of travel, population increase, population displacement, pollution, agricultural activity, changing socioeconomic structures, and international conflicts worldwide have each contributed to infectious disease events. Today, however, nothing is larger in scale, has more potential for long-term effects, and is more uncertain than the effects of climate change on infectious disease outbreaks, epidemics, and pandemics. We discuss advances in our ability to predict these events and, in particular, the critical role that satellite imaging could play in mounting an effective response. PMID:19788799

  14. Pathways of Polyunsaturated Fatty Acid Utilization: Implications for Brain Function in Neuropsychiatric Health and Disease

    PubMed Central

    Liu, Joanne J.; Green, Pnina; Mann, J. John; Rapoport, Stanley I.; Sublette, M. Elizabeth

    2014-01-01

    Essential polyunsaturated fatty acids (PUFAs) have profound effects on brain development and function. Abnormalities of PUFA status have been implicated in neuropsychiatric diseases such as major depression, bipolar disorder, schizophrenia, Alzheimer’s disease, and attention deficit hyperactivity disorder. Pathophysiologic mechanisms could involve not only suboptimal PUFA intake, but also metabolic and genetic abnormalities, defective hepatic metabolism, and problems with diffusion and transport. This article provides an overview of physiologic factors regulating PUFA utilization, highlighting their relevance to neuropsychiatric disease. PMID:25498862

  15. Utility of health states in chronic kidney disease: a structured review of the literature.

    PubMed

    Dale, P L; Hutton, J; Elgazzar, H

    2008-01-01

    To document published utilities for health states associated with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) and determine the most appropriate values for use in economic models to evaluate renal treatments in the UK. A structured literature review was conducted (MEDLINE, EMBASE, NHS EED and HTA) in order to identify relevant articles published between January 1990 and January 2006. In addition searches were conducted on websites of Health Technology Assessment (HTA) organizations and the Cost Effectiveness Analysis Registry. Articles were reviewed and those not containing utilities excluded. Results were assessed on the quality of the elicitation studies and their relevance to the UK HTA environment. Thirty-five studies satisfied the inclusion criteria. Most studies were conducted in Canada (13), the US (10) and the Netherlands (4). Utilities were identified for all/most of the necessary states, but scores for individual states differed widely between studies and very few studies met the quality criteria. The majority of studies used the time trade-off (23) and standard gamble (11) to elicit utilities, while only six used EQ-5D. Seven studies provided community preferences. Two studies were judged to be directly relevant to economic evaluations in the UK. Many studies have estimated utilities in ESRD patients, but only a few have estimated utilities based upon public preferences. Further empirical research is needed to produce more reliable utilities for economic modelling in the UK, especially in chronic kidney disease patients who do not require dialysis.

  16. Sickle-cell disease in California: a population-based description of emergency department utilization.

    PubMed

    Wolfson, Julie A; Schrager, Sheree M; Coates, Thomas D; Kipke, Michele D

    2011-03-01

    Acute and chronic clinical manifestations of sickle-cell disease (SCD) lead to significant healthcare utilization, especially of the emergency department (ED). Limited population-level data are available in SCD with the ability to connect patients to visits, leaving us with minimal description of utilization patterns. Using ED discharge data with links between patients and visits, we sought to describe the California SCD population and its ED utilization patterns across facilities. Non-public California Office of Statewide Health Planning and Development data employ unique patient identifiers, linking patients, and visits. SCD patients of all ages are heavily reliant on Medicaid (46%). The majority of SCD Californians visit an ED more than once during a year (69%), but only a minority use more than one facility during a year (34%). However, adults with SCD have multiple visits and utilize multiple EDs in higher proportions than do children (72% vs. 60% and 40% vs. 21%, respectively). A higher proportion of visits to the ED are made by SCD adults, but a higher proportion of visits by children result in hospital admission. Uninsured adults outnumber uninsured children (16% vs. 5%). ED utilization by the California SCD population is described on a population level. Utilization patterns by adults point towards increased utilization in the population no longer eligible for Title V pediatric coverage for their disease. Further investigation using population-level socioeconomic and geographic correlates is warranted to evaluate the factors leading to ED utilization in SCD. Copyright © 2010 Wiley-Liss, Inc.

  17. The Physician's Assistant in a Rural Satellite Clinic: Report on an Evaluative Case Study of Utilization, Acceptance and Economics.

    ERIC Educational Resources Information Center

    Hill, Robert; And Others

    In an effort to mitigate the maldistribution of U.S. physicians, a rural satellite clinic was established in 1973 to serve the 1,239 citizens of Yale, Oklahoma. The clinic was manned by a graduate of the two year Physician's Associate program at the University of Oklahoma who was under the supervision and employ of a pediatrician located 20 miles…

  18. Molecular characterization of begomoviruses and DNA satellites associated with okra leaf curl disease in Cameroon.

    PubMed

    Leke, Walter N; Sattar, Muhammad N; Ngane, Emilia B; Ngeve, Jacob M; Kvarnheden, Anders; Brown, Judith K

    2013-06-01

    Okra leaf curl disease (OLCD) is the most important viral disease of okra in West Africa. In this study, a complex of begomoviruses and associated DNA satellites were identified in symptomatic okra plants from southwestern Cameroon. Sequence analyses showed that two of the plants (Lik1 and Njo5) were infected with a begomovirus being a recombinant of cotton leaf curl Gezira virus (CLCuGeV) and okra yellow crinkle virus (OYCrV). The recombinant genome shared highest nucleotide identity with isolates of CLCuGeV at 87.8% and is therefore considered to be member of a new begomovirus species, Okra leaf curl Cameroon virus (OLCuCMV). One plant (Mue5) was infected by a begomovirus with 95.8% nucleotide identy to CLCuGeV, while in the plants Lik1, Mue1 and Njo5, a begomovirus was identified showing highest nucleotide identity at 93.7% with OYCrV. The nucleotide comparisons and phylogenetic analyses suggest that these isolates represent new Cameroonian strains of CLCuGeV and OYCrV (CLCuGeV-CM and OYCrV-CM). Mixed infection of OLCuCMV and OYCrV-CM was found in two of the plants. A betasatellite and two divergent alphasatellites were also associated with the begomoviruses. The betasatellite was identified as cotton leaf curl Gezira betasatellite (CLCuGeB) with the highest nucleotide identity at 93.3% to other African isolates of CLCuGeB. The alphasatellites, herein named Alpha-1 and Alpha-2, shared 97.3% and 95.2% identity, respectively, with cotton leaf curl Gezira alphasatellite (CLCuGeA) and okra leaf curl Burkina Faso alphasatellite (OLCuBFA). These collective results emphasize the extent of diversity among okra-infecting begomovirus-satellite complexes in western Africa.

  19. Health care utilization of patients with multiple chronic diseases in The Netherlands: Differences and underlying factors.

    PubMed

    Hopman, Petra; Heins, Marianne J; Rijken, Mieke; Schellevis, François G

    2015-04-01

    To examine health care utilization of people with multiple chronic diseases in The Netherlands compared to people with one chronic disease, and to identify different subgroups of multimorbid patients based on differences in health care utilization. All patients diagnosed with one or more chronic diseases in 2008-2009 (N=17,443) were selected from the nationwide NIVEL Primary Care Database, and data on their GP contacts were included. Data on hospital admissions (from the Dutch Hospital Data database) and household size and income (from the Integral Household Incomes database 2010) were added. Chi-square-tests and multivariate regression analyses were performed to test for differences between multimorbid patients and patients with one chronic disease, and between subgroups of multimorbid patients derived from cluster analysis. Multimorbid patients (40% of the total sample) had more GP contacts, prescribed medications, and hospital admissions (all p<.0001) than patients with one chronic disease. The largest cluster of multimorbid patients (80%) was characterized by a relatively low level of health care utilization. Two smaller clusters comprised patients with a (very) high level of health care utilization - these people were mainly older, more often female, had a lower income, a smaller household size, and suffered from more chronic diseases. Among the vast majority of multimorbid patients health care utilization is only slightly higher compared to patients with one chronic disease. Extensive health care utilization among people with multimorbidity seems to be related to patient characteristics as well as illness characteristics. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  20. Deriving health utilities from the MacNew Heart Disease Quality of Life Questionnaire.

    PubMed

    Chen, Gang; McKie, John; Khan, Munir A; Richardson, Jeff R

    2015-10-01

    Quality of life is included in the economic evaluation of health services by measuring the preference for health states, i.e. health state utilities. However, most intervention studies include a disease-specific, not a utility, instrument. Consequently, there has been increasing use of statistical mapping algorithms which permit utilities to be estimated from a disease-specific instrument. The present paper provides such algorithms between the MacNew Heart Disease Quality of Life Questionnaire (MacNew) instrument and six multi-attribute utility (MAU) instruments, the Euroqol (EQ-5D), the Short Form 6D (SF-6D), the Health Utilities Index (HUI) 3, the Quality of Wellbeing (QWB), the 15D (15 Dimension) and the Assessment of Quality of Life (AQoL-8D). Heart disease patients and members of the healthy public were recruited from six countries. Non-parametric rank tests were used to compare subgroup utilities and MacNew scores. Mapping algorithms were estimated using three separate statistical techniques. Mapping algorithms achieved a high degree of precision. Based on the mean absolute error and the intra class correlation the preferred mapping is MacNew into SF-6D or 15D. Using the R squared statistic the preferred mapping is MacNew into AQoL-8D. The algorithms reported in this paper enable MacNew data to be mapped into utilities predicted from any of six instruments. This permits studies which have included the MacNew to be used in cost utility analyses which, in turn, allows the comparison of services with interventions across the health system. © The European Society of Cardiology 2014.

  1. Utilization of Meteorological Satellite Imagery for World-Wide Environmental Monitoring the Lower Mississippi River Flood of 1979 - Case 1. [St. Louis, Missouri

    NASA Technical Reports Server (NTRS)

    Helfert, M. R.; Mccrary, D. G.; Gray, T. I. (Principal Investigator)

    1981-01-01

    The 1979 Lower Mississippi River flood was selected as a test case of environmental disaster monitoring utilizing NOAA-n imagery. A small scale study of the St. Louis Missouri area comparing ERTS-1 (LANDSAT) and NOAA-2 imagery and flood studies using only LANDSAT imagery for mapping the Rad River of the North, and Nimbus-5 imagery for East Australia show the nonmeteorological applications of NOAA satellites. While the level of NOAA-n imagery detail is not that of a LANDSAT image, for operational environmental monitoring users the NOAA-n imagery may provide acceptable linear resolution and spectral isolation.

  2. Health utility of patients with Crohn's disease and ulcerative colitis: a systematic review and meta-analysis.

    PubMed

    Malinowski, Krzysztof Piotr; Kawalec, Paweł

    2016-08-01

    The aim of this systematic review was to collect and summarize the current data on the utilities of patients with Crohn's disease (CD) and ulcerative colitis (UC). A meta-analysis of the obtained utilities was performed using a random-effects model and meta-regression by the disease type and severity. A bootstrap analysis was performed as it does not require assumption on distribution of the data. The highest utility among patients with CD and UC was observed when the diseases were in remission. The meta-regression analysis showed that both disease severity and an instrument/method/questionnaire used to obtain utilities were significant predictors of utility. Utility was the lowest for severe disease and the highest for disease in remission, the association was more notable in patients with CD compared with UC. Expert commentary: The issue of patients' utility is important for healthcare decision makers but it has not been fully investigated and requires further study.

  3. Resource utilization and survival among Medicare patients with advanced liver disease.

    PubMed

    Otgonsuren, Munkhzul; Henry, Linda; Hunt, Sharon; Venkatesan, Chapy; Mishra, Alita; Younossi, Zobair M

    2015-02-01

    The prevalence of advanced liver disease and its complications may be on the rise within the Medicare population. The study aim was trend assessment for prevalence, mortality and resource utilization of patients with advanced liver disease. A retrospective, cross-sectional design was used to analyze a national sample of non-institutionalized Medicare in/outpatients from 2005 to 2009. Cases were ascertained by International Classification of Diseases, 9th Edition. Outcomes were overall mortality (within 1 year) and resource utilization [hospital length of stay (LOS/days) and institutional costs to Medicare]. Multivariate analyses were used to estimate the odds ratios for mortality predictors; linear regression was used for resource utilization predictors. A total of 21,913 beneficiaries with advanced liver disease were identified in the Medicare inpatient and outpatient administrative data sets from 2005 to 2009. Over 70 % of the beneficiaries with advanced liver disease died during study time period with 17 % dying while hospitalized. Predictors of mortality were: admission to the intensive care unit (ICU) and increasing Charlson Comorbidity Index. Predictors for increased LOS and cost were: ICU admission and having a thoracentesis procedure (both indicators of the levels of illness). Advanced liver disease and its related complication are increasing in the Medicare population and are associated with very high mortality. Further study is warranted to understand the drivers of the increased prevalence of advanced liver disease for earlier identification and treatment.

  4. Health care costs, utilization and patterns of care following Lyme disease.

    PubMed

    Adrion, Emily R; Aucott, John; Lemke, Klaus W; Weiner, Jonathan P

    2015-01-01

    Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome - a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses. Lyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care costs and utilization.

  5. Health Care Costs, Utilization and Patterns of Care following Lyme Disease

    PubMed Central

    Adrion, Emily R.; Aucott, John; Lemke, Klaus W.; Weiner, Jonathan P.

    2015-01-01

    Background Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome – a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. Objectives 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. Methods This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Results Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses. Conclusions Lyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care

  6. Utility of WHOQOL-BREF in measuring quality of life in Sickle Cell Disease

    PubMed Central

    Asnani, Monika R; Lipps, Garth E; Reid, Marvin E

    2009-01-01

    Background Sickle cell disease is the commonest genetic disorder in Jamaica and most likely exerts numerous effects on quality of life (QOL) of those afflicted with it. The WHOQOL-Bref, which is a commonly utilized generic measure of quality of life, has never previously been utilized in this population. We have sought to study its utility in this disease population. Methods 491 patients with sickle cell disease were administered the questionnaire including demographics, WHOQOL-Bref, Short Form-36 (SF-36), Flanagan's quality of life scale (QOLS) and measures of disease severity at their routine health maintenance visits to the sickle cell unit. Internal consistency reliabilities, construct validity and "known groups" validity of the WHOQOL-Bref, and its domains, were examined; and then compared to those of the other instruments. Results All three instruments had good internal consistency, ranging from 0.70 to 0.93 for the WHOQOL-Bref (except the 'social relationships' domain), 0.86–0.93 for the SF-36 and 0.88 for the QOLS. None of the instruments showed any marked floor or ceiling effects except the SF-36 'physical health' and 'role limitations' domains. The WHOQOL-Bref scale also had moderate concurrent validity and showed strong "known groups" validity. Conclusion This study has shown good psychometric properties of the WHOQOL-Bref instrument in determining QOL of those with sickle cell disease. Its utility in this regard is comparable to that of the SF-36 and QOLS. PMID:19664266

  7. Hospital-based inpatient resource utilization associated with autosomal dominant polycystic kidney disease in the US.

    PubMed

    Blanchette, Christopher M; Craver, Christopher; Belk, Kathy W; Lubeck, Deborah P; Rossetti, Sandro; Gutierrez, Benjamin

    2015-04-01

    Polycystic kidney disease (PKD) is a clinically and genetically heterogeneous class of genetic disorders characterized by development of renal cysts leading to renal failure and end stage renal disease (ESRD). Autosomal dominant polycystic kidney disease (ADPKD) accounts for the majority of PKD cases and is the predominant monogenic cause of ESRD. Limited information on patient characteristics and healthcare resource utilization is available in this population. This study assessed hospital-based inpatient utilization of patients with ADPKD in the US to help further understand the disease, which may lead to treatments that delay progression and reduce healthcare resource utilization. A cross-sectional analysis was conducted using MedAssets Health System Data to investigate inpatient resource utilization for a total of 1876 patients hospitalized with ADPKD or chronic kidney disease (CKD). Patient characteristics and inpatient resource utilization were compared between hospitalized patients with ADPKD and CKD, including demographic and clinical characteristics, overall health, rates of complications and surgical interventions, and average length of hospital and intensive care unit stay. Compared with patients with CKD, patients with ADPKD were more likely to have commercial insurance as their primary payer (36.1 vs 17.8%) and were significantly younger (mean age 57.9 vs 69.5 years) and generally healthier (Charlson Comorbidity Score of 2.0 vs 3.3). Patients with ADPKD also had a substantially shorter average length of hospital stay (6.3 vs 10.3 days). However, patients with ADPKD experienced more kidney-related complications and a higher surgical procedure rate (mainly for transplant and complete nephrectomy). Although patients with ADPKD were generally healthier than patients with CKD, specific kidney function complications were more frequent. Patients with ADPKD had a higher rate of major kidney procedures, which may contribute to the high burden of ADPKD

  8. Analysis of lake level changes in Nam Co in central Tibet utilizing synergistic satellite altimetry and optical imagery

    NASA Astrophysics Data System (ADS)

    Kropáček, Jan; Braun, Andreas; Kang, Shichang; Feng, Chen; Ye, Qinghua; Hochschild, Volker

    2012-07-01

    The fluctuations of closed basin lakes on the Tibetan Plateau are a valuable record of climate change induced water balance alterations within the catchments. Since these basins are remote and hard to access, multisensoral remote sensing is a valuable method to gather the necessary water budget components with appropriate spatial coverage and with high temporal resolutions. Thus the lake level elevation changes of the central Tibetan lake Nam Co were examined in example by a comparison of satellite altimetry (RA-2/ENVISAT, GFO radar altimeters and GLAS/ICESat laser altimeter for the period 2000-2009) and the evaluation of a time series of optical satellite data dating back to 1976 (Landsat) and 1965 (Corona) in order to validate hydrological water budget modelling results. The combination of all three altimeters revealed a rising trend of lake level on average by 0.31 m/year in the period 2000-2009 which corresponds to a total volume change of 6.2 km3. This is in a good agreement with simulated average lake level rise of 0.35 m/year obtained from distributed hydrological modelling (Krause et al., 2010). The movements of lakeshore measured on the satellite imagery confirm the trend revealed by the altimetry data and they also indicate the rising trend since 1965. While GFO provides a dense time series of data the more accurate ENVISAT/RA-2 data unfortunately feature large data gaps over Tibet. The measurements from time limited campaigns of ICESat validate the results of radar altimetry and they provide unlike radar altimeters a valid height over lake ice during winter and spring period. The results show that the presented approach is a valuable contribution to understand the impact of changing climate on the hydrology of Tibetan lakes.

  9. In flight ground control of high drag satellites utilizing on-board accelerometer data and rapid orbit prediction techniques

    NASA Technical Reports Server (NTRS)

    Fuchs, A. J.; Velez, C. E.

    1974-01-01

    High drag satellites frequently require precise verification of orbital maneuvers and the accurate prediction of perigee height. An in-flight ground support system designed to monitor and compute orbital state and maneuvers is described. The use of on-board three-axis accelerometer data in a flight support software system to perform on-line maneuver analysis and atmospheric model updating is discussed. In addition, automated analytic techniques to rapidly and accurately predict perigee height following a maneuver are described, as well as semianalytic averaging techniques designed to predict a decaying orbital state for mission control.

  10. Horizontal inequity in public health care service utilization for non-communicable diseases in urban Vietnam

    PubMed Central

    Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Weinehall, Lars; Ng, Nawi

    2014-01-01

    Background A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). Design A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas. PMID:25095780

  11. Accurate Identification of Fatty Liver Disease in Data Warehouse Utilizing Natural Language Processing.

    PubMed

    Redman, Joseph S; Natarajan, Yamini; Hou, Jason K; Wang, Jingqi; Hanif, Muzammil; Feng, Hua; Kramer, Jennifer R; Desiderio, Roxanne; Xu, Hua; El-Serag, Hashem B; Kanwal, Fasiha

    2017-08-31

    Natural language processing is a powerful technique of machine learning capable of maximizing data extraction from complex electronic medical records. We utilized this technique to develop algorithms capable of "reading" full-text radiology reports to accurately identify the presence of fatty liver disease. Abdominal ultrasound, computerized tomography, and magnetic resonance imaging reports were retrieved from the Veterans Affairs Corporate Data Warehouse from a random national sample of 652 patients. Radiographic fatty liver disease was determined by manual review by two physicians and verified with an expert radiologist. A split validation method was utilized for algorithm development. For all three imaging modalities, the algorithms could identify fatty liver disease with >90% recall and precision, with F-measures >90%. These algorithms could be used to rapidly screen patient records to establish a large cohort to facilitate epidemiological and clinical studies and examine the clinic course and outcomes of patients with radiographic hepatic steatosis.

  12. A review of health utilities using the EQ-5D in studies of cardiovascular disease

    PubMed Central

    2010-01-01

    Background The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease. Methods A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included. Results Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients. Conclusions The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area. PMID:20109189

  13. Performance and utility of satellite telemetry during field studies of free-ranging polar bears in Alaska

    USGS Publications Warehouse

    Garner, Gerald W.; Amstrup, Steven C.; Douglas, David C.; Gardner, Craig L.; Amlaner, Charles J.

    1989-01-01

    Satellite telemetry technology has been used during field studies of polar bears in Alaska since 1985. A total of 109 Platform Transmitter Terminals (PTT) have been deployed on free-ranging female polar bears that seasonally inhabit waters adjacent to the Alaskan coast. The PTTs transmitted locational and sensor data to TIROS-N polar-orbiting satellites during a duty cycle of 12 hours on/60 hours off in 1985, 1986, and 1987. Expected battery life was 13.8 months, and collars were normally removed and replaced with new or refurbished PTTs at 11-13 month intervals. Duty cycles were altered to 7-8 hours on/64-65 hours off in 1988 to prolong expected battery life to 19-21 months. Sensor data transmitted included PTT internal temperature, short term activity counts recorded at 60 second intervals, and long term activity counts for the preceding 24 or 72-hour period. Early failures of PTTs to fix location (less than 75% of expected battery life) were as high as 53% during 198501986. Subsequent improvements in battery design, including better shock insulation, improved electronic, and an improved battery system have reduced early failures to 27% in 1987-1988. The harsh environment and the degree of abuse observed in recovered collars indicate that an unavoidable failure rate of 8-10% is inherent within 60 days after deployment on polar bears. A total of 18,000 locations and 201,000 sensor messages were received from female polar bears between May 1985 and June 1988. Polar bears that were marked in Alaskan waters have been located as far south as 60°N 168°W, and as far east as 70°N 127°W in the Beaufort Sea. Polar bears in the Beaufort Sea are shared with Canada, while polar bears in the Chukchi and Bering seas are shared with the Soviet Union. The international ranges of the two hypothesized populations have been documented. Satellite telemetry has detailed the large movement patterns of polar bear over these vast areas that were previously not available using other

  14. Utilizing low-cost 3U single-sensor satellites for intelligence, surveillance, and reconnaissance mission capabilities

    NASA Astrophysics Data System (ADS)

    Huang, Philip M.; Knuth, Andrew A.; Garrison-Darrin, Margaret A.

    2012-06-01

    Leveraging low cost launch carriers for small satellites with the functionality required for DoD and intelligence missions realizes a hidden potential capability. The Multi-Mission Bus Demonstration (MBD) is a Johns Hopkins University Applied Physics Laboratory (JHU/APL) program to demonstrate military operational relevance in a 3U CubeSat form factor. The MBD spacecraft caters to mission versatility and responsive launch capabilities with a standardized bus and interchangeable payload interface design. MBD embraced the challenge of building two space vehicles on an extremely aggressive timeline and demanding budget, causing the development team to evaluate every step of the process to maximize efforts with minimal manpower and cost. MBD is providing a classified DoD payload capability that is truly operationally relevant and may revolutionize the mission area. As a single instrument or payload satellite, also called a SensorSat, MBD is a spacecraft of realizable ISR benefits including effective remote sensing, simplified engineering design and program requirements, and reduced time to launch, all yielding an appealing cost per unit. The SensorSat has potential to detect sufficient information that will act as a complementary component to tactical commanders in heightening battlefield awareness. Recent advancements in technology has put capabilities such as precision navigation, communication intelligence, signal intelligence, tactical warning, environmental intelligence, and a wide variety of ground imaging, at the tip of culmination in a small, economical package. This paper reviews the high functionality of the MBD spacecraft in the miniaturized footprint of 10 cm by 10 cm by 30cm which allows the mission to leverage inexpensive launch opportunities.

  15. Assessing the Utility of Satellite Imagery with Differing Spatial Resolutions for Deriving Proxy Measures of Slum Presence in Accra, Ghana.

    PubMed

    Stoler, Justin; Daniels, Dean; Weeks, John R; Stow, Douglas A; Coulter, Lloyd L; Finch, Brian Karl

    2012-01-01

    Little research has been conducted on how differing spatial resolutions or classification techniques affect image-driven identification and categorization of slum neighborhoods in developing nations. This study assesses the correlation between satellite-derived land cover and census-derived socioeconomic variables in Accra, Ghana to determine whether the relationship between these variables is altered with a change in spatial resolution or scale. ASTER and Landsat TM satellite images are each used to classify land cover using spectral mixture analysis (SMA), and land cover proportions are summarized across Enumeration Areas in Accra and compared to socioeconomic data for the same areas. Correlation and regression analyses compare the SMA results with a Slum Index created from various socio-economic data taken from the Census of Ghana, as well as to data derived from a "hard" per-pixel classification of a 2.4 m Quickbird image. Results show that the vegetation fraction is significantly correlated with the Slum Index (Pearson's r ranges from -0.33 to -0.51 depending on which image-derived product is compared), and the use of a spatial error model improves results (multivariate model pseudo-R(2) ranges from 0.37 to 0.40 by image product). We also find that SMA products derived from ASTER are a sufficient substitute for classification products derived from higher spatial resolution QB data when using land cover fractions as a proxy for slum presence, suggesting that SMA might be more cost-effective for deriving land cover fractions than the use of high-resolution imagery for this type of demographic analysis.

  16. Health Care Utilization among Migrant Latino Farmworkers: The Case of Skin Disease

    PubMed Central

    Feldman, Steven R.; Vallejos, Quirina M.; Quandt, Sara A.; Fleischer, Alan B.; Schulz, Mark R.; Verma, Amit; Arcury, Thomas A.

    2009-01-01

    Context Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing healthcare resources. Purpose Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods 304 migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and healthcare utilization over a single agricultural season. Self-reported and dermatologist-diagnosed skin condition data were collected at baseline and at up to four follow-up assessments. Medical visit rates were compared to national norms. Findings Self-reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self-treatment for skin conditions was common, including use of non-prescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year. Conclusions The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self-treatment. Clinic-based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates. PMID:19166568

  17. Quality of life and health care utilization in patients with chronic respiratory diseases.

    PubMed

    Kurpas, D; Mroczek, B; Sitko, Z; Helicka, D; Kuchar, E

    2015-01-01

    High quality of life (QoL) may reduce the costs of medical care of chronically ill patients due to lower health care utilization. The purpose of this study was to establish the influence of the QoL of primary care patients with chronic respiratory diseases on the level of health care utilization and the predictors of hospitalization. The study group consisted of 594 adult patients with chronic respiratory diseases of the mean age 59.8±14.9 years. The highest QoL was observed in the social relationship domain and the lowest in the physical domain. Low QoL was associated with a low level of health care utilization among patients with chronic respiratory diseases. Most patients were hospitalized during the past 3 years. In a group of patients with chronic respiratory diseases, chances for hospitalization were: higher among patients with low QoL and health satisfaction, low QoL levels in the physical and social relationship domains, high QoL levels in the psychological domain, those with higher education, residents of rural areas, patients using frequent consultations over the phone, and those with at least an average index of services.

  18. Distributed land surface modeling with utilization of multi-sensor satellite data: application for the vast agricultural terrain in cold region

    NASA Astrophysics Data System (ADS)

    Muzylev, E.; Uspensky, A.; Gelfan, A.; Startseva, Z.; Volkova, E.; Kukharsky, A.; Romanov, P.; Alexandrovich, M.

    2012-04-01

    A technique for satellite-data-based modeling water and heat regimes of a large scale area has been developed and applied for the 227,300 km2 agricultural region in the European Russia. The core component of the technique is the physically based distributed Remote Sensing Based Land Surface Model (RSBLSM) intended for simulating transpiration by vegetation and evaporation from bare soil, vertical transfer of water and heat within soil and vegetation covers during a vegetation season as well as hydrothermal processes in soil and snow covers during a cold season, including snow accumulation and melt, dynamics of soil moisture and temperature during soil freezing and thawing, infiltration into frozen soil. Processes in the "atmosphere-snow-frozen soil" system are critical for cold region agriculture, as they control crop development in early spring before the vegetation season beginning. For assigning the model parameters as well as for preliminary calibrating and validating the model, available multi-year data sets of soil moisture/temperature profiles, evaporation, snow and soil freezing depth measured at the meteorological stations located within the study region have been utilized. To provide an appropriate parametrization of the model for the areas where ground-based measurements are unavailable, estimates have been utilized for vegetation, meteorological and snow characteristics derived from the multispectral measurements of AVHRR/NOAA (1999-2010), MODIS/EOS Terra & Aqua (2002-2010), AMSR-E/Aqua (2003-2004; 2008-2010), and SEVIRI/Meteosat-9 (2009-2010). The technologies of thematic processing the listed satellite data have been developed and applied to estimate the land surface and snow cover characteristics for the study area. The developed technologies of AVHRR data processing have been adapted to retrieve land surface temperature (LST) and emissivity (E), surface-air temperature at a level of vegetation cover (TA), normalized vegetation index (NDVI), leaf

  19. Gene-based vaccines and immunotherapeutic strategies against neurodegenerative diseases: Potential utility and limitations.

    PubMed

    Kudrna, Jeremy J; Ugen, Kenneth E

    2015-01-01

    There has been a recent expansion of vaccination and immunotherapeutic strategies from controlling infectious diseases to the targeting of non-infectious conditions including neurodegenerative disorders. In addition to conventional vaccine and immunotherapeutic modalities, gene-based methods that express antigens for presentation to the immune system by either live viral vectors or non-viral naked DNA plasmids have been developed and evaluated. This mini-review/commentary summarizes the advantages and disadvantages, as well as the research findings to date, of both of these gene-based vaccination approaches in terms of how they can be targeted against appropriate antigens within the Alzheimer and Parkinson disease pathogenesis processes as well as potentially against targets in other neurodegenerative diseases. Most recently, the novel utilization of these viral vector and naked DNA gene-based technologies includes the delivery of immunoglobulin genes from established biologically active monoclonal antibodies. This modified passive immunotherapeutic strategy has recently been applied to deliver passive antibody immunotherapy against the pathologically relevant amyloid β protein in Alzheimer disease. The advantages and disadvantages of this technological application of gene-based immune interventions, as well as research findings to date are also summarized. In sum, it is suggested that further evaluation of gene based vaccines and immunotherapies against neurodegenerative diseases are warranted to determine their potential clinical utility.

  20. Perceived Health Status and Utilization of Specialty Care: Racial and Ethnic Disparities in Patients with Chronic Diseases

    ERIC Educational Resources Information Center

    Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.

    2010-01-01

    Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…

  1. Perceived Health Status and Utilization of Specialty Care: Racial and Ethnic Disparities in Patients with Chronic Diseases

    ERIC Educational Resources Information Center

    Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.

    2010-01-01

    Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…

  2. Satellite Capabilities Mapping - Utilizing Small Satellites

    DTIC Science & Technology

    2010-09-01

    Related to the CubeSat Size……………………..24 Table 5. Solar Radiation Particle Types and Effects …………………………………….26 Table 6. SESS Sensor Descriptions...acquisitions can be done” [3]. A smallsat may be defined by different characteristics such as size, weight, power, and cost are the most common. These...Reconnaissance (ISR). [4]” For example, solar energetic particles accelerated by a coronal mass ejection (CME) or solar flare can damage electronics

  3. Computers and small satellites: How FORTE is utilizing the WWW as a {open_quotes}paperless{close_quotes} information resource and the development of a unique resource management planning tool

    SciTech Connect

    Roussel-Dupre, D.; Carter, M.; Franz, R.

    1997-10-01

    The Fast-On-orbit Recording of Transient Events (FORTE) satellite is the second satellite to be developed and flown by Los Alamos National Laboratory and is scheduled to be launched August, 1997 by a Pegasus XL rocket. FORTE follows in the footsteps of the ALEXIS satellite in utilizing a very small operations crew for mission operations. Partially based upon the ALEXIS automation and World Wide Web (WWW) usage for data dissemination, FORTE began at an early stage of ground processing to use the web as a repository of information about all aspects of the satellite. Detailed descriptions of the various satellite and experiment components, cable diagrams, integration photographs as well as extensive test data have all been compiled into a single site as a means of archiving the data at a single location. In this manner, it is readily available during times of ground testing, ground station operation training as well as anomaly resolution. Small satellites usually require extensive effort to optimize operation under minimal resources. For the FORTE satellite, a unique planning tool has been developed over the past 2 years which balances the various resources of the satellite (power, memory, downlink, on board command buffer, etc.) to provide the maximum data acquisition. This paper will concentrate on a description of both the extensive web interface and the planning tool. 6 refs.

  4. Clinical Utility of Serologic Testing for Celiac Disease in Asymptomatic Patients

    PubMed Central

    2011-01-01

    Executive Summary Objective The objective of this evidence-based analysis was to evaluate the clinical utility of serologic testing for celiac disease in asymptomatic individuals presenting with one of the non-gastrointestinal conditions evaluated in this report. The clinical utility was based on the effects of a gluten-free diet (GFD) on outcomes specific to each of these conditions. The prevalence of celiac disease in asymptomatic individuals and one of these non-gastrointestinal conditions was also evaluated. Clinical Need and Target Population Celiac Disease Celiac disease is an autoimmune disease characterized by a chronic inflammatory state of the proximal small bowel mucosa accompanied by structural and functional changes. Technology Under Evaluation Serologic Tests for Celiac Disease There are a number of serologic tests for celiac disease available. Serologic tests are automated with the exception of the anti-endomysial antibody test, which is more time-consuming and operator-dependent than the other tests. Research Questions What is the prevalence of asymptomatic celiac disease in patients presenting with one of the non-gastrointestinal conditions evaluated? What is the effect of the gluten-free diet on condition-specific outcomes in patients with asymptomatic celiac disease presenting with one of the non-gastrointestinal conditions evaluated? What is the clinical utility of serologic testing for celiac disease in asymptomatic patients presenting with one of the non-gastrointestinal conditions evaluated? The clinical utility was defined as the impact of the GFD on disease specific outcomes. What is the risk of all-cause mortality and lymphoma in individuals with asymptomatic celiac disease? What is the budget impact of serologic testing for celiac disease in asymptomatic subjects presenting with one of the non-gastrointestinal conditions evaluated? Research Methods Study Population The study population consisted of individuals with newly diagnosed celiac

  5. Resource utilization before and during infliximab therapy in patients with inflammatory bowel disease.

    PubMed

    Waters, Heidi C; Vanderpoel, Julie E; Nejadnik, Bijan; McKenzie, R Scott; Lunacsek, Orsolya E; Lennert, Barbara J; Goff, John; Augustyn, Damian H

    2012-01-01

    Although Remicade (infliximab) is costly relative to non-biologic therapy, its impact on healthcare resource utilization and mucosal healing may make it a cost-effective option. This study aimed to compare gastrointestinal (GI)-related healthcare resource utilization and severity of mucosal damage before and during infliximab therapy in Crohn's disease (CD) or ulcerative colitis (UC) patients. A retrospective chart review was conducted at 14 gastroenterology practices from across the country, which varied in practice sizes and types. Patients were aged ≥18 years, diagnosed with CD or UC, and had an infliximab index date between January 1, 2005 and September 30, 2007. GI-related utilization 12 months before and 12 months after the index date was compared. Endoscopic disease severity was categorized based on blinded review of abstracted reports. Results from 268 patients indicated significantly lower rates of surgery (29.7% to 9.9%, p < 0.0001, CD; 24.4% to 12.8%, p = 0.042, UC) and colonoscopy (54.4% to 17.6%, p < 0.0001, CD; 50.0% to 22.1%, p = 0.0007, UC) during infliximab therapy. The rates of hospitalizations in UC (15.1% to 3.5%, p = 0.0124) and radiology assessments in CD (23.1% to 10.4%, p = 0.006) also decreased. Based on severity data from 183 procedures, greater proportions of patients had normal or mild ratings during infliximab treatment compared with pre-treatment. This retrospective descriptive study is limited by the type and quantity of information available in patient charts from 14 gastroenterology clinics during the first year of infliximab treatment. In addition, the number of patients with pre-treatment and post-treatment disease severity information was too small to make comparisons among disease severity groups. Further information about the severity of disease and the extent of mucosal healing could be helpful in determining the effect of therapy on resource utilization in future research. GI-related resource

  6. Can a chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization?

    PubMed

    Rasekaba, T M; Williams, E; Hsu-Hage, B

    2009-01-01

    Chronic obstructive pulmonary disease (COPD) imposes a costly burden on healthcare. Pulmonary rehabilitation (PR) is the best practice to better manage COPD to improve patient outcomes and reduce acute hospital care utilization. To evaluate the impact of a once-weekly, eight-week multidisciplinary PR program as an integral part of the COPD chronic disease management (CDM) Program at Kyabram District Health Services. The study compared two cohorts of COPD patients: CDM-PR Cohort (4-8 weeks) and Opt-out Cohort (0-3 weeks) between February 2006 and March 2007. The CDM-PR Program involved multidisciplinary patient education and group exercise training. Nonparametric statistical tests were used to compare acute hospital care utilization 12 months before and after the introduction of CDM-PR. The number of patients involved in the CDM-PR Cohort was 29 (n = 29), and that in the Opt-out Cohort was 24 (n = 24). The CDM-PR Cohort showed significant reductions in cumulative acute hospital care utilization indicators (95% emergency department presentations, 95% inpatient admissions, 99% length of stay; effect sizes = 0.62-0.66, P < 0.001) 12 months after the introduction of the CDM Program; in contrast, changes in the cumulative indicators were statistically insignificant for the Opt-out Cohort (emergency department presentations decreased by 5%, inpatient admissions decreased by 12%, length of stay increased by 30%; effect size = 0.14-0.40, P > 0.05). Total costs associated with the hospital care utilization decreased from $130,000 to $7,500 for the CDM-PR Cohort and increased from $77,700 to $101,200 for the Opt-out Cohort. Participation in the CDM-PR for COPD patients can significantly reduce acute hospital care utilization and associated costs in a small rural health service.

  7. Clinical utility of (18)F-fluoride PET/CT in benign and malignant bone diseases.

    PubMed

    Li, Yuxin; Schiepers, Christiaan; Lake, Ralph; Dadparvar, Simin; Berenji, Gholam R

    2012-01-01

    (18)F labeled sodium fluoride is a positron-emitting, bone seeking agent with more favorable skeletal kinetics than conventional phosphate and diphosphonate compounds. With the expanding clinical usage of PET/CT, there is renewed interest in using (18)F-fluoride PET/CT for imaging bone diseases. Growing evidence indicates that (18)F fluoride PET/CT offers increased sensitivity, specificity, and diagnostic accuracy in evaluating metastatic bone disease compared to (99m)Tc based bone scintigraphy. National Oncologic PET Registry (NOPR) has expanded coverage for (18)F sodium fluoride PET scans since February 2011 for the evaluation of osseous metastatic disease. In this article, we reviewed the pharmacological characteristics of sodium fluoride, as well as the clinical utility of PET/CT using (18)F-fluoride in both benign and malignant bone disorders.

  8. Patterns of cerebral glucose utilization in depression, multiple infarct dementia, and Alzheimer's disease

    SciTech Connect

    Kuhl, D.E.; Metter, E.J.; Riege, W.H.

    1983-01-01

    Patterns of local cerebral glucose utilization were determined in moderately to severely disabled patients with depression (n=7), multiple infarct dementia (n=6), and Alzheimer's disease (n=6), and in normal controls (n=6), using positron emission tomography with the /sup 18/F-fluorodeoxyglucose method. Average global metabolic rate was decreased 30% in patients with Alzheimer's disease, but overlap among the other groups reduced the discriminant value of this measure. In depressed patients, the cerebral metabolic pattern was normal, except for evidence of hypometabolic zone in the posterior-inferior frontal cortex which was of marginal statistical significance. In multiple infarct dementia, focal metabolic defects were scattered throughout the brain and exceeded the extent of infarction. In Alzheimer's disease, metabolism was markedly reduced in cortex, especially parietal cortex, but relatively preserved in caudate, thalamus, anterior cingulate gyrus, pre and post central gyrus, and calcarine occipital cortex, a pattern duplicating the degree and location of pathological and neurochemical alterations characteristic of this disorder.

  9. Utilizing satellite-derived estimates of land surface temperature and vegetation characteristics in modeling the vertical water and heat fluxes for a river basin

    NASA Astrophysics Data System (ADS)

    Muzylev, E. L.; Uspensky, A. B.; Startseva, Z. P.; Volkova, E. V.; Kukharsky, A. V.

    2009-04-01

    New version of the model of vertical water and heat transfer in the "soil-vegetation-atmosphere" system (SVAT) has been developed, accounting for land surface heterogeneities in river basin. The model is specially designed to assimilate satellite data and is intended for calculation of evapotranspiration Ev, soil water content W, sensible and latent heat fluxes and other water and heat balance components as well as vertical soil moisture and temperature profiles and vegetation cover and soil surface temperatures for any time interval within vegetation season. The river basin landscape patchiness is represented in the model with soil constants, leaf area index LAI, vegetation cover fraction B, land surface albedo A, and other vegetation characteristics that were treated as model parameters. The Seim River basin was chosen for investigation, situated in forest-steppe zone of the Central Russia (Kursk region) with watershed area equal to 7460 km2. Satellite-derived estimates of land surface characteristics have been extracted from AVHRR/NOAA (1999-2006 vegetation seasons) and MODIS/EOS Terra and Aqua (2003-2005 vegetation seasons) cloud-free data. The developed technique of AVHRR data processing provides the cloud detection and the retrieval of soil temperature Тsg and emissivity E, surface-air temperature at a level of vegetation cover Ta, effective radiative temperature Ts.eff (weighted linear combination of Ta and Tsg), as well as the derivation of normalized vegetation index NDVI, LAI and B. The updated multi-threshold technique of cloud detection in the AVHRR field of view has been applied to increase the reliability of cloud-free fragments selection. The algorithms of Ta, Ts.eff, Tg derivation utilize linear regression estimators similar to well-known "local" split window technique. The values of E for these regression formulas have been specified using empirical relationships between E and B, E and NDVI as well as the emissivity models for various surface

  10. Clinical utility of serologic testing for celiac disease in asymptomatic patients: an evidence-based analysis.

    PubMed

    2011-01-01

    The objective of this evidence-based analysis was to evaluate the clinical utility of serologic testing for celiac disease in asymptomatic individuals presenting with one of the non-gastrointestinal conditions evaluated in this report. The clinical utility was based on the effects of a gluten-free diet (GFD) on outcomes specific to each of these conditions. The prevalence of celiac disease in asymptomatic individuals and one of these non-gastrointestinal conditions was also evaluated. CELIAC DISEASE: Celiac disease is an autoimmune disease characterized by a chronic inflammatory state of the proximal small bowel mucosa accompanied by structural and functional changes. TECHNOLOGY UNDER EVALUATION: SEROLOGIC TESTS FOR CELIAC DISEASE: There are a number of serologic tests for celiac disease available. Serologic tests are automated with the exception of the anti-endomysial antibody test, which is more time-consuming and operator-dependent than the other tests. What is the prevalence of asymptomatic celiac disease in patients presenting with one of the non-gastrointestinal conditions evaluated?What is the effect of the gluten-free diet on condition-specific outcomes in patients with asymptomatic celiac disease presenting with one of the non-gastrointestinal conditions evaluated?What is the clinical utility of serologic testing for celiac disease in asymptomatic patients presenting with one of the non-gastrointestinal conditions evaluated? The clinical utility was defined as the impact of the GFD on disease specific outcomes.What is the risk of all-cause mortality and lymphoma in individuals with asymptomatic celiac disease?What is the budget impact of serologic testing for celiac disease in asymptomatic subjects presenting with one of the non-gastrointestinal conditions evaluated? The study population consisted of individuals with newly diagnosed celiac disease without any symptoms consistent with the disease presenting with one of the non-gastrointestinal conditions

  11. Bayesian probability analysis: a prospective demonstration of its clinical utility in diagnosing coronary disease

    SciTech Connect

    Detrano, R.; Yiannikas, J.; Salcedo, E.E.; Rincon, G.; Go, R.T.; Williams, G.; Leatherman, J.

    1984-03-01

    One hundred fifty-four patients referred for coronary arteriography were prospectively studied with stress electrocardiography, stress thallium scintigraphy, cine fluoroscopy (for coronary calcifications), and coronary angiography. Pretest probabilities of coronary disease were determined based on age, sex, and type of chest pain. These and pooled literature values for the conditional probabilities of test results based on disease state were used in Bayes theorem to calculate posttest probabilities of disease. The results of the three noninvasive tests were compared for statistical independence, a necessary condition for their simultaneous use in Bayes theorem. The test results were found to demonstrate pairwise independence in patients with and those without disease. Some dependencies that were observed between the test results and the clinical variables of age and sex were not sufficient to invalidate application of the theorem. Sixty-eight of the study patients had at least one major coronary artery obstruction of greater than 50%. When these patients were divided into low-, intermediate-, and high-probability subgroups according to their pretest probabilities, noninvasive test results analyzed by Bayesian probability analysis appropriately advanced 17 of them by at least one probability subgroup while only seven were moved backward. Of the 76 patients without disease, 34 were appropriately moved into a lower probability subgroup while 10 were incorrectly moved up. We conclude that posttest probabilities calculated from Bayes theorem more accurately classified patients with and without disease than did pretest probabilities, thus demonstrating the utility of the theorem in this application.

  12. Dose-response effects for disease management programs on hospital utilization in Illinois Medicaid.

    PubMed

    Berg, Gregory D; Donnelly, Shawn; Miller, Mary; Medina, Wendie; Warnick, Kathleen

    2012-12-01

    The objective of this study is to estimate a dose-response impact of disease management contacts on inpatient admissions. Multivariate regression analysis of panel data was used to test the hypothesis that increased disease management contacts lower the odds of an inpatient admission. Subjects were 40,452 members of Illinois' noninstitutionalized Medicaid-only aged, blind, or disabled population diagnosed with asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, and/or heart failure. All members are also in the state's Illinois Health Connect program, a medical home strategy in place for most of the 2.4 million Illinois Medicaid beneficiaries. The statistical measure is the odds ratio, which is a measure of association between the monthly inpatient admission indicator and the number of contacts (doses) a member has had for each particular disease management intervention. Statistically significant contacts are between 8 and 12 for heart failure, between 4 and 12 contacts for diabetes, and between 8 and 13 contacts for asthma. Total inpatient savings during the study period is estimated to be $12.4 million. This study shows the dose-response pattern of inpatient utilization improvements through the number of disease management contacts.

  13. Consumer-driven health plans: impact on utilization and expenditures for chronic disease sufferers.

    PubMed

    Nair, Kavita V; Park, Jinhee; Wolfe, Pamela; Saseen, Joseph J; Allen, Richard Read; Ganguly, Rahul

    2009-05-01

    The impact of consumer-driven health plans (CDHPs) on utilization and expenditures for members with chronic diseases. Analyzed claims data from a national employer who switched from a preferred provider organization (PPO) plan to offering only CDHPs in 2005. A matched comparison group of PPO members was used. Analysis was conducted using generalized estimating equations for repeated measures. Compared with the PPO group, the CDHP group had lower: outpatient visits (-36% vs -22%), laboratory services (-34.3% vs -19%), emergency room (odds ratio [OR]: 0.1 vs 0.6), and inpatient visits (OR: 0.35 vs 0.68), and medication adherence (OR: 0.7 vs 1.0). Reductions in health care expenditures were not statistically different between the groups (-28% vs -15%, P = 0.5). Switching to a CDHP resulted in lower utilization and adherence. Potential underutilization of necessary services should be addressed in future research.

  14. Evaluating the Utility of Satellite Soil Moisture Retrievals over Irrigated Areas and the Ability of Land Data Assimilation Methods to Correct for Unmodeled Processes

    NASA Technical Reports Server (NTRS)

    Kumar, S. V.; Peters-Lidard, C. D.; Santanello, J. A.; Reichle, R. H.; Draper, C. S.; Koster, R. D.; Nearing, G.; Jasinski, M. F.

    2015-01-01

    Earth's land surface is characterized by tremendous natural heterogeneity and human-engineered modifications, both of which are challenging to represent in land surface models. Satellite remote sensing is often the most practical and effective method to observe the land surface over large geographical areas. Agricultural irrigation is an important human-induced modification to natural land surface processes, as it is pervasive across the world and because of its significant influence on the regional and global water budgets. In this article, irrigation is used as an example of a human-engineered, often unmodeled land surface process, and the utility of satellite soil moisture retrievals over irrigated areas in the continental US is examined. Such retrievals are based on passive or active microwave observations from the Advanced Microwave Scanning Radiometer for the Earth Observing System (AMSR-E), the Advanced Microwave Scanning Radiometer 2 (AMSR2), the Soil Moisture Ocean Salinity (SMOS) mission, WindSat and the Advanced Scatterometer (ASCAT). The analysis suggests that the skill of these retrievals for representing irrigation effects is mixed, with ASCAT-based products somewhat more skillful than SMOS and AMSR2 products. The article then examines the suitability of typical bias correction strategies in current land data assimilation systems when unmodeled processes dominate the bias between the model and the observations. Using a suite of synthetic experiments that includes bias correction strategies such as quantile mapping and trained forward modeling, it is demonstrated that the bias correction practices lead to the exclusion of the signals from unmodeled processes, if these processes are the major source of the biases. It is further shown that new methods are needed to preserve the observational information about unmodeled processes during data assimilation.

  15. Evaluating the Utility of Satellite Soil Moisture Retrievals over Irrigated Areas and the Ability of Land Data Assimilation Methods to Correct for Unmodeled Processes

    NASA Technical Reports Server (NTRS)

    Kumar, S. V.; Peters-Lidard, C. D.; Santanello, J. A.; Reichle, R. H.; Draper, C. S.; Koster, R. D.; Nearing, G.; Jasinski, M. F.

    2015-01-01

    Earth's land surface is characterized by tremendous natural heterogeneity and human-engineered modifications, both of which are challenging to represent in land surface models. Satellite remote sensing is often the most practical and effective method to observe the land surface over large geographical areas. Agricultural irrigation is an important human-induced modification to natural land surface processes, as it is pervasive across the world and because of its significant influence on the regional and global water budgets. In this article, irrigation is used as an example of a human-engineered, often unmodeled land surface process, and the utility of satellite soil moisture retrievals over irrigated areas in the continental US is examined. Such retrievals are based on passive or active microwave observations from the Advanced Microwave Scanning Radiometer for the Earth Observing System (AMSR-E), the Advanced Microwave Scanning Radiometer 2 (AMSR2), the Soil Moisture Ocean Salinity (SMOS) mission, WindSat and the Advanced Scatterometer (ASCAT). The analysis suggests that the skill of these retrievals for representing irrigation effects is mixed, with ASCAT-based products somewhat more skillful than SMOS and AMSR2 products. The article then examines the suitability of typical bias correction strategies in current land data assimilation systems when unmodeled processes dominate the bias between the model and the observations. Using a suite of synthetic experiments that includes bias correction strategies such as quantile mapping and trained forward modeling, it is demonstrated that the bias correction practices lead to the exclusion of the signals from unmodeled processes, if these processes are the major source of the biases. It is further shown that new methods are needed to preserve the observational information about unmodeled processes during data assimilation.

  16. Evaluating the utility of satellite soil moisture retrievals over irrigated areas and the ability of land data assimilation methods to correct for unmodeled processes

    NASA Astrophysics Data System (ADS)

    Kumar, S. V.; Peters-Lidard, C. D.; Santanello, J. A.; Reichle, R. H.; Draper, C. S.; Koster, R. D.; Nearing, G.; Jasinski, M. F.

    2015-11-01

    Earth's land surface is characterized by tremendous natural heterogeneity and human-engineered modifications, both of which are challenging to represent in land surface models. Satellite remote sensing is often the most practical and effective method to observe the land surface over large geographical areas. Agricultural irrigation is an important human-induced modification to natural land surface processes, as it is pervasive across the world and because of its significant influence on the regional and global water budgets. In this article, irrigation is used as an example of a human-engineered, often unmodeled land surface process, and the utility of satellite soil moisture retrievals over irrigated areas in the continental US is examined. Such retrievals are based on passive or active microwave observations from the Advanced Microwave Scanning Radiometer for the Earth Observing System (AMSR-E), the Advanced Microwave Scanning Radiometer 2 (AMSR2), the Soil Moisture Ocean Salinity (SMOS) mission, WindSat and the Advanced Scatterometer (ASCAT). The analysis suggests that the skill of these retrievals for representing irrigation effects is mixed, with ASCAT-based products somewhat more skillful than SMOS and AMSR2 products. The article then examines the suitability of typical bias correction strategies in current land data assimilation systems when unmodeled processes dominate the bias between the model and the observations. Using a suite of synthetic experiments that includes bias correction strategies such as quantile mapping and trained forward modeling, it is demonstrated that the bias correction practices lead to the exclusion of the signals from unmodeled processes, if these processes are the major source of the biases. It is further shown that new methods are needed to preserve the observational information about unmodeled processes during data assimilation.

  17. Evaluating the utility of satellite soil moisture retrievals over irrigated areas and the ability of land data assimilation methods to correct for unmodeled processes

    NASA Astrophysics Data System (ADS)

    Kumar, S. V.; Peters-Lidard, C. D.; Santanello, J. A.; Reichle, R. H.; Draper, C. S.; Koster, R. D.; Nearing, G.; Jasinski, M. F.

    2015-06-01

    The Earth's land surface is characterized by tremendous natural heterogeneity and human engineered modifications, both of which are challenging to represent in land surface models. Satellite remote sensing is often the most practical and effective method to observe the land surface over large geographical areas. Agricultural irrigation is an important human induced modifications to natural land surface processes, as it is pervasive across the world and because of its significant influence on the regional and global water budgets. In this article, irrigation is used as an example of a human engineered, unmodeled land surface process, and the utility of satellite soil moisture retrievals over irrigated areas in the continental US is examined. Such retrievals are based on passive or active microwave observations from the Advanced Microwave Scanning Radiometer for the Earth Observing System (AMSR-E), the Advanced Microwave Scanning Radiometer 2 (AMSR2), the Soil Moisture Ocean Salinity (SMOS) mission, WindSat and the Advanced Scatterometer (ASCAT). The analysis suggests that the skill of these retrievals for representing irrigation artifacts is mixed, with ASCAT based products somewhat more skillful than SMOS and AMSR2 products. The article then examines the suitability of typical bias correction strategies in current land data assimilation systems when unmodeled processes dominate the bias between the model and the observations. Using a suite of synthetic experiments that includes bias correction strategies such as quantile mapping and trained forward modeling, it is demonstrated that the bias correction practices lead to the exclusion of the signals from unmodeled processes, if these processes are the major source of the biases. It is further shown that new methods are needed to preserve the observational information about unmodeled processes during data assimilation.

  18. Screening Utility of the King-Devick Test in Mild Cognitive Impairment and Alzheimer Disease Dementia.

    PubMed

    Galetta, Kristin M; Chapman, Kimberly R; Essis, Maritza D; Alosco, Michael L; Gillard, Danielle; Steinberg, Eric; Dixon, Diane; Martin, Brett; Chaisson, Christine E; Kowall, Neil W; Tripodis, Yorghos; Balcer, Laura J; Stern, Robert A

    2016-06-13

    The King-Devick (K-D) test is a 1 to 2 minute, rapid number naming test, often used to assist with detection of concussion, but also has clinical utility in other neurological conditions (eg, Parkinson disease). The K-D involves saccadic eye and other eye movements, and abnormalities thereof may be an early indicator of Alzheimer disease (AD)-associated cognitive impairment. No study has tested the utility of the K-D in AD and we sought to do so. The sample included 206 [135 controls, 39 mild cognitive impairment (MCI), and 32 AD dementia] consecutive subjects from the Boston University Alzheimer's Disease Center registry undergoing their initial annual evaluation between March 2013 and July 2015. The K-D was administered during this period. Areas under the receiver operating characteristic curves generated from logistic regression models revealed the K-D test distinguished controls from subjects with cognitive impairment (MCI and AD dementia) [area under the curve (AUC)=0.72], MCI (AUC=0.71) and AD dementia (AUC=0.74). K-D time scores between 48 and 52 seconds were associated with high sensitivity (>90.0%) and negative predictive values (>85.0%) for each diagnostic group. The K-D correlated strongly with validated attention, processing speed, and visual scanning tests. The K-D test may be a rapid and simple effective screening tool to detect cognitive impairment associated with AD.

  19. Clinical characteristics and healthcare utilization of patients with multicentric Castleman disease.

    PubMed

    Casper, Corey; Teltsch, Dana Y; Robinson, Don; Desrosiers, Marie-Pierre; Rotella, Philip; Dispenzieri, Angela; Qi, Ming; Habermann, Thomas; Reynolds, Matthew W

    2015-01-01

    Multicentric Castleman disease (MCD) is a rare lymphoproliferative disease. Little is known about how patient clinical features and healthcare utilization varies by human immunodeficiency virus (HIV) status and disease subtype. Data of MCD patients identified between 2000 and 2009 were collected from medical records at two United States treatment centres. Clinical, demographic, and biochemical characteristics, drug therapies and medical utilization were descriptively reported by HIV status and cell histology, and statistically compared with the Fisher's Exact and Kruskal-Wallis tests. Patients (n = 59) had a pathologically and clinically confirmed MCD diagnosis: plasmacytic (42%), hyaline vascular (29%) and mixed (15%); 10% had HIV infection. In the first year after diagnosis, MCD patients on average saw a healthcare provider more than six times, were hospitalized at least once and underwent frequent radiological and laboratory testing. Rituximab was the most commonly used drug therapy, followed by corticosteroids and conventional chemotherapy. One- and 2-year survival was excellent in HIV-negative patients (100% and 97%, respectively) but inferior for HIV-positive cases (67% and 67%, respectively). Heterogeneous treatment decisions were observed in this MCD study; HIV status was the only distinguishing clinical criteria associated with pharmacotherapies. Additional research is necessary to guide treatment of this rare lymphoproliferative disorder. © 2014 John Wiley & Sons Ltd.

  20. Trends in outpatient resource utilizations and outcomes for Medicare beneficiaries with nonalcoholic fatty liver disease.

    PubMed

    Younossi, Zobair M; Zheng, Li; Stepanova, Maria; Henry, Linda; Venkatesan, Chapy; Mishra, Alita

    2015-03-01

    Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. The objective of this study was to describe the recent trend of health care resource utilization and short-term mortality of Medicare beneficiaries with NAFLD. This study utilized data from a random sample of national outpatient claims of Medicare beneficiaries (2005 to 2010) who sought outpatient care for NAFLD. This study included 29,528 patients who sought outpatient care for NAFLD from 2005 to 2010. The annual number of patients increased consistently from 3585 in 2005 to 6646 in 2010. The prevalence of studied comorbidities including cardiovascular disease, diabetes, hyperlipidemia, and hypertension also increased significantly. At the same time, the mean yearly charge and the mean yearly payment increased significantly from $2624±$3308 and $561±$835 in 2005 to $3608±$5132 and $629±$1157 (P<0.05), respectively. The observed mortality rate remained stable around 2.84% (P=0.64). After adjusting for the other covariates, the total number of outpatient visits and all the comorbidities considered were the most determinant factors for yearly charge and yearly payment (P<0.0001). Overall mortality was associated with age, gender, number of outpatient visits, diabetes, and hyperlipidemia. The number of outpatient visits because of NAFLD rose between 2005 and 2010. Short-term mortality rates remained stable throughout the study period, whereas total annual charges and payments increased.

  1. Evolution of a cost-utility model of donepezil for Alzheimer's disease.

    PubMed

    Peters, Jaime L; Anderson, Rob; Hoyle, Martin; Hyde, Chris

    2013-04-01

    The aim of this study was to describe the evolution of a cost-utility model used to inform the UK National Institute for Health and Clinical Excellence's (NICE) most recent decisions on the cost-utility of drug treatments for Alzheimer's disease (AD), and to explore the impact of structural assumptions on the cost-utility results. Changes informed by noted limitations of the decision model used in NICE's previous decisions (in 2006) were made cumulatively to the original decision model for donepezil compared with best supportive care (for patients with mild to moderate AD). Deterministic and probabilistic analyses were undertaken for each cumulative change of the model. The expected value of perfect information (EVPI) of parameter estimates and structural assumptions was also calculated. Cumulative changes to the decision model highlighted how the results of the original model (incremental cost-effectiveness ratio of £81,000 per quality-adjusted life-year gained) related to those of the new model (where donepezil was estimated to be cost-saving), mainly due to uncertainty in the incremental cost of donepezil treatment over best supportive care (ranging from -£600 to £3,000 per patient). The partial EVPI analysis reflected this finding where further information on treatment discontinuations and cost parameter estimates were shown to be valuable in terms of reducing decision uncertainty. Assessing the evolution of the cost-utility model helped to identify and explore structural differences between cohort-based models and is likely to be useful for decision models in other disease areas. This approach makes the structural uncertainty explicit, forcing decision makers to address structural uncertainty in addition to parameter uncertainty.

  2. Cost-utility analysis of biologic treatments for moderate-to-severe Crohn's disease.

    PubMed

    Tang, Derek H; Armstrong, Edward P; Lee, Jeannie K

    2012-06-01

    To compare the cost versus utility of four guideline-recommended biologic treatments-infliximab, adalimumab, certolizumab pegol, and natalizumab-for the treatment of Crohn's disease from a United States payer perspective. Cost-utility decision analytic model using a Monte Carlo simulation of 10,000 cases. Published primary and tertiary literature. Patients with moderate-to-severe Crohn's disease, as categorized by the Crohn's Disease Activity Index, that failed to respond to standard therapy and who were treatment naive to biologics. The decision analytic model base case was a 35-year-old patient weighing 70 kg with moderate-to-severe Crohn's disease. Therapeutic efficacy data were obtained from published clinical trials. Online prescription drug, hospitalization data, and Current Procedural Terminology codes were used to estimate cost. Utility measures were estimated using published data obtained from patients with Crohn's disease. The time end point used for the model was 54 weeks. The analysis demonstrated considerable overlap in quality-adjusted life years gained with the four agents (i.e., mean values across four treatments 0.79-0.80). Although infliximab had the lowest median cost, there was overlap in the 95% confidence intervals (CIs) compared with the other three biologic products: mean (95% CI) cost for infliximab $22,663 ($19,105-26,433), adalimumab $27,515 ($23,796-31,584), certolizumab pegol $29,062 ($24,952-33,882), and natalizumab $31,166 ($25,915-37,195). However, the cost-effectiveness acceptability curve demonstrated that infliximab had the most scenarios (95.2%) when it was the most cost-effective biologic therapy using a willingness-to-pay threshold of $100,000/quality-adjusted life years gained. Patients with moderate-to-severe Crohn's disease that failed to respond to standard treatment should preferentially receive infliximab as their initial biologic treatment, since this agent had the highest probability of being the most cost

  3. Utilizing health ambassadors to improve type 2 diabetes and cardiovascular disease outcomes in Gadsden County, Florida.

    PubMed

    Suther, Sandra; Battle, Arrie M; Battle-Jones, Felecia; Seaborn, Cynthia

    2016-04-01

    Minority racial and ethnic groups are at higher risk for developing type 2 diabetes. These groups also experience more severe complications from diabetes and have higher mortality rates as a result of the disease, such as cardiovascular disease, amputation and kidney failure. Underserved rural ethnically disparate populations benefit from health education outreach efforts that are conveyed and translated by specially-trained community health ambassadors. Project H.I.G.H. (Helping Individuals Get Healthy) was developed to target the priority areas of type 2 diabetes and cardiovascular disease. Utilizing trained community health ambassadors, CDC's The Road to Health Toolkit as well as New Beginnings: A Discussion Guide for Living Well with Diabetes was used as a model for a community-based educational program. The overall goal of Project H.I.G.H was to implement and evaluate: (1) a coordinated, behavior-focused, family-centered, community-based educational program and; (2) a client service coordination effort resulting in improved health outcomes (BMI, Glucose Levels, BP) for individuals with type 2 diabetes and cardiovascular disease in Gadsden County, Florida. Overall, Project H.I.G.H. was very successful in its first year at motivating participants to delay or prevent diabetes and/or cardiovascular disease or at the very least to start taking better care of their health.

  4. Detection and analysis of morphotectonic features utilizing satellite remote sensing and GIS: An example in SW Jordan

    NASA Astrophysics Data System (ADS)

    Radaideh, Omar M. A.; Grasemann, Bernhard; Melichar, Rostislav; Mosar, Jon

    2016-12-01

    This study investigates the dominant orientations of morphological features and the relationship between these trends and the spatial orientation of tectonic structures in SW Jordan. Landsat 8 and hill-shaded images, constructed from 30 m-resolution ASTER-GDEM data, were used for automatically extracting and mapping geological lineaments. The ASTER-GDEM was further utilized to automatically identify and extract drainage network. Morphological features were analyzed by means of azimuth frequency and length density distributions. Tectonic controls on the land surface were evaluated using longitudinal profiles of many westerly flowing streams. The profiles were taken directly across the northerly trending faults within a strong topographic transition between the low-gradient uplands and the deeply incised mountain front on the east side of the Dead Sea Fault Zone. Streams of the area are widely divergent, and show numerous anomalies along their profiles when they transect faults and lineaments. Five types of drainage patterns were identified: dendritic, parallel, rectangular, trellis, and modified dendritic/trellis. Interpretation and analysis of the lineaments indicate the presence of four main lineament populations that trend E-W, N-S, NE-SW, and NW-SE. Azimuthal distribution analysis of both the measured structures and drainage channels shows similar trends, except for very few differences in the prevailing directions. The similarity in orientation of lineaments, drainage system, and subsurface structural trends highlights the degree of control exerted by underlying structure on the surface geomorphological features. Faults and lineaments serve as a preferential conduit for surface running waters. The extracted lineaments were divided into five populations based on the main age of host rocks outcropping in the study area to obtain information about the temporal evolution of the lineament trends through geologic time. A general consistency in lineament trends over

  5. Real-time quantitative PCR assay for the quantification of virus and satellites causing leaf curl disease in cotton in Pakistan.

    PubMed

    Shafiq, Muhammad; Iqbal, Zafar; Ali, Irfan; Abbas, Qamar; Mansoor, Shahid; Briddon, Rob W; Amin, Imran

    2017-10-01

    Cotton leaf curl disease (CLCuD) is the major biotic constraint to cotton production in Pakistan and northwestern India. The disease is caused by monopartite begomoviruses in association with a specific DNA satellite, Cotton leaf curl Multan betasatellite. The virus-betasatellite complex is also frequently associated with another DNA satellite-like molecule; an alphasatellite. A quantitative real-time PCR (qPCR) assay to detect all three components of the monopartite begomovirus/betasatellite/alphasatellite complex which causes CLCuD was established. This was used to investigate the relationship between symptoms and virus/satellite titre. Not surprisingly the analysis showed that, overall, there was a reasonable correlation between symptom severity and virus/satellite titre - more severe symptoms usually being associated with more virus/satellite. However, cotton plants were identified with no or very mild symptoms with relatively high virus/satellite titres and plants with severe symptoms but relatively low virus/satellite titres. This may be attributed to the resistance/susceptibility of the cotton variety - tolerant plants being able to sustain a relatively high virus/satellite titre whilst exhibiting mild symptoms. The usefulness of this qPCR procedure in the screening for resistance in cotton against CLCuD is discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. The potential utilizations of hydrogen as a promising therapeutic strategy against ocular diseases

    PubMed Central

    Tao, Ye; Geng, Lei; Xu, Wei-Wei; Qin, Li-Min; Peng, Guang-Hua; Huang, Yi-Fei

    2016-01-01

    Hydrogen, one of the most well-known natural molecules, has been used in numerous medical applications owing to its ability to selectively neutralize cytotoxic reactive oxygen species and ameliorate hazardous inflammations. Hydrogen can exert protective effects on various reactive oxygen species-related diseases, including the transplantation-induced intestinal graft injury, chronic inflammation, ischemia–reperfusion injuries, and so on. Especially in the eye, hydrogen has been used to counteract multiple ocular pathologies in the ophthalmological models. Herein, the ophthalmological utilizations of hydrogen are systematically reviewed and the underlying mechanisms of hydrogen-induced beneficial effects are discussed. It is our hope that the protective effects of hydrogen, as evidenced by these pioneering studies, would enrich our pharmacological knowledge about this natural element and cast light into the discovery of a novel therapeutic strategy against ocular diseases. PMID:27279745

  7. [Guidelines for the diagnosis and management of thyroid disease and their utility].

    PubMed

    Hashimoto, Koshi; Mori, Masatomo

    2012-11-01

    Thyroid dysfunction is a common disorder in daily clinical practice, however due to unspecific and diverse symptoms of the disease, it is sometimes hard to make a definite diagnosis. Japan thyroid association (JTA) published 'Guideline for the diagnosis of thyroid disease, 2010' and it is open to the public on the JTA website(http : //www.japanthyroid.jp/doctor/ guideline/japanese.html). English version of the guideline is also available. JTA also published 'Guideline for the management of subclinical hypothyroidism 2008' and 'Guideline for the diagnosis of thyroid storm, version 2'. The latter in English version has been published in Thyroid(http : //www.ncbi.nlm.nih.gov/pubmed/22494618). The utility of these guidelines is discussed.

  8. Confrontation naming does not add incremental diagnostic utility in MCI and Alzheimer's disease.

    PubMed

    Testa, Julie A; Ivnik, Robert J; Boeve, Bradley; Petersen, Ronald C; Pankratz, V Shane; Knopman, David; Tangalos, Eric; Smith, Glenn E

    2004-07-01

    As the incidence of dementia increases, there is a growing need to determine the diagnostic utility of specific neuropsychological tests in the early diagnosis of Alzheimer's disease (AD). In this study, the relative utility of Boston Naming Test (BNT) in the diagnosis of AD was examined and compared to the diagnostic utility of other neuropsychological measures commonly used in the evaluation of AD. Individuals with AD (n = 306), Mild Cognitive Impairment (MCI; n = 67), and cognitively normal subjects (n = 409) with at least 2 annual evaluations were included. Logistic regression analysis suggested that initial BNT impairment is associated with increased risk of subsequent AD diagnosis. However, this risk is significantly less than that imparted by measures of delayed recall impairments. A multivariate Cox proportional hazards regression analysis suggested that BNT impairment imparted no additional risk for subsequent AD diagnosis after delayed recall impairments were included in the model. Although BNT impairment occurred in all severity groups, it was ubiquitous only in moderate to severe dementia. Collectively these results suggest that although BNT impairments become more common as AD progresses, they are neither necessary for the diagnosis of AD nor particularly useful in identifying early AD.

  9. Initialization and state updating utilizing the OpenDA platform and Sentinel Satellite Series data for ecological modeling in the North Sea*

    NASA Astrophysics Data System (ADS)

    Ziemba, Alexander; El Serafy, Ghada

    2017-04-01

    Ecological modeling relies on the mathematical reconstruction of natural processes which results in a simplification of interactions between a vast number of ecological functions and variables. Despite this simplification, models are able to provide an approximation of the future states of environmental systems, however, inherit therein is a degree of uncertainty due to the simplifications. In order to compensate for these uncertainties and resulting errors, it is possible to anneal real world measurements from both Remote Sensing and In-Situ observations into the model space utilizing data assimilation. Given this, the OpenDA platform and related algorithms are employed in order to initialize the model space and update the model states during hindcasting simulations in order to provide an optimal departure state from which forecasts can be made. Through such a method, future model states have a reduced uncertainty band and provide deterministic results with higher accuracy. This methodology is applied to the prediction of chlorophyll-a concentrations within the southern coastal zone of the North Sea, focusing primarily on the Dutch coastal zone and the Wadden Sea. By utilizing data assimilation with the Sentinel Satellite Series data, an improved forecast is obtained as seen through a comparison of both purely deterministic runs as well as ensemble results which do not implement DA. Various combination of Sentinel data re used in order to evaluate the efficacy and benefit of introducing multiple data sets in the DA process for Coastal and Estuarine Ecological modeling. *This work has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 641762

  10. An evaluation of universal health insurance in the elderly: burden of disease, utilization, and costs in the Republic of Korea.

    PubMed

    Peabody, John W; Robalino, David A; Kim, Jin Ho

    2002-05-01

    This article evaluates Korea's national health insurance system for the elderly by simultaneously examining disease patterns, demand for care, utilization, costs of care, and facility type. Claim records (N = 8,306,976) for 1995 to 1997 were obtained from the Youndeoung-Po district for four insurance categories. Utilization is examined using a probit model; a linear regression model is used to compare costs. Insurees averaged 10.6 medical visits per year, most commonly for acute respiratory diseases. The elderly were more likely to seek care for circulatory problems, use more inpatient services, and rely on hospitals for outpatient care. Insurance costs for the elderly poor were markedly higher, and overall care for the elderly was higher per visit. By simultaneously analyzing utilization rates, disease patterns, and relative costs of care, policymakers may be able to avert a financing crisis. Stronger pricing strategies and better disease targeting would adjust utilization and increase efficiency of health expenditures.

  11. Roles and interactions of begomoviruses and satellite DNAs associated with okra leaf curl disease in Mali, West Africa.

    PubMed

    Kon, Tatsuya; Rojas, Maria R; Abdourhamane, Issoufou K; Gilbertson, Robert L

    2009-04-01

    Okra leaf curl disease (OLCD) is a major constraint on okra (Abelmoschus esculentus) production in West Africa. Two monopartite begomoviruses (okra virus-1 and okra virus-2), a betasatellite and a DNA1 satellite are associated with OLCD in Mali. Okra virus-1 is an isolate of okra yellow crinkle virus (OYCrV), okra virus-2 is a recombinant isolate of cotton leaf curl Gezira virus (CLCuGV) and the betasatellite is a variant of cotton leaf curl Gezira betasatellite (CLCuGB). Cloned DNA of OYCrV and CLCuGV were infectious and induced leaf curl symptoms in Nicotiana benthamiana plants, but did not induce OLCD in okra. However, when these clones were individually co-inoculated with the cloned CLCuGB DNA, symptom severity and viral DNA levels were increased in N. benthamiana plants and typical OLCD symptoms were induced in okra. The CLCuGB was also replicated by, and increased symptom severity of, three monopartite tomato-infecting begomoviruses, including two from West Africa. The sequence of the DNA1 satellite was highly divergent, indicating that it represents a distinct West African lineage. DNA1 replicated autonomously, and replication required the DNA1-encoded Rep protein. Although DNA1 reduced helper begomovirus DNA levels, symptoms were not attenuated. In the presence of CLCuGB, DNA levels of the helper begomoviruses and DNA1 were substantially increased. Together, these findings establish that OLCD in Mali is caused by a complex of monopartite begomoviruses and a promiscuous betasatellite with an associated parasitic DNA1 satellite. These findings are discussed in terms of the aetiology of OLCD and the evolution of new begomovirus/satellite DNA complexes.

  12. Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey

    PubMed Central

    Dunai, Andrea; Keszei, Andras P.; Kopp, Maria S.; Shapiro, Colin M.; Mucsi, Istvan; Novak, Marta

    2008-01-01

    Study Objectives: We assessed the prevalence of self-reported snoring in the Hungarian population and established whether different types of snoring are associated with cardiovascular disorders and increased health-care utilization. Design: Cross-sectional study. Door-to-door survey. Setting: Nationally representative population in Hungary. Participants: Interviews were carried out in the homes of 12,643 persons. We used the Hungarian National Population Register as the sampling frame and implemented a clustered, stratified sampling procedure. The study population represented 0.16% of the population over the age of 18 years according to age, sex, and 150 subregions of the country. Interventions: Not applicable. Measurements and Results: Thirty-seven percent of men and 21% of women reported loud snoring with breathing pauses. Hypertension, myocardial infarction, and stroke were reported by 26%, 3%, and 4% of the respondents, respectively. There was a significant increase in the prevalence of hypertension, myocardial infarction, and stroke in quiet and loud snorers, as compared with nonsnorers. Multivariate analysis showed an association between loud snoring and hypertension (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.24 – 1.58), myocardial infarction (OR: 1.34, CI: 1.04 – 1.73), and stroke (OR: 1.67, CI: 1.32 – 2.11) after statistical adjustment for age, sex, body mass index, diabetes, level of education, smoking, and alcohol consumption. Loud snoring was also associated with measures of health-care use in both sexes. Conclusions: Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization. Citation: Dunai A; Keszei AP; Kopp MS; Shapiro CM; Mucsi I; Novak M. Cardiovascular disease and health-care utilization in snorers: a population survey. SLEEP 2008;31(3):411-416. PMID:18363318

  13. [Utilization of health care resources and cost associated to fasciectomy in Dupuytren's disease in Spain].

    PubMed

    De Salas-Cansado, Marina; Belén Ruiz Antorán, María; Ramírez, Elena; Dudley, Antonio

    2013-01-01

    To estimate the healthcare resource utilization and their associated costs secondary to fasciectomy of Dupuytren s disease (DD) treated under usual medical practice in Spain. This multicenter, observational, retrospective cohort study, extracted data through the revision of medical records of three tertiary public hospitals. Each center should recruit 40 patients operated for DD, as principal diagnose of Minimum Data Set, in which the surgical procedure conducted was fasciectomy, during 2007-2009. To collect all the resources used during surgery, a specific chart form was designed. Demographic (age, gender, occupational status), clinical (stage of contracture and comorbilities) and healthcare utilization (hospitalizations, medical visits, tests, drugs) data were collected under medical routine. Comparisons between stage of contracture grouped (I: stage N, 1 & 2; II: stage 3 & 4) and centers were made. A total of 123 subjects (52% group I; 86.2% men; 35.8% active workers) were identified. 81.3% of patients presented at least one comorbidity, being hypertension the most frequent. 28.4% of patients were operated in ambulatory surgery and 71.6% hospitalized. All the patients had follow-up visits after surgery, 27% needed physical therapy, 88% performed preoperative tests and 8% visit the emergency room after surgery. Healthcare mean (SD) costs were as follows: fasciectomy €1,074 (0); hospitalizations €978 (743); ambulatory €186 (10); follow-up visits €260 (173); emergency rooms €13 (53); tests €78(43); drugs €7 (9); physical therapy €46 (134). Mean total costs were €2,250 (839). There were no significant differences between study groups grouped by stage of contracture. However, the center and the severity of the CD seem explanatory variables of cost, p<0.05. Healthcare resources utilization for surgical treatment of Dupuytren's disease may cost €2,250 (839) per fasciectomy treated under usual medical practice. Copyright © 2013 SEFH. Published by

  14. Trends in resource utilization associated with the inpatient treatment of neonatal congenital heart disease.

    PubMed

    Smith, Andrew H; Gay, James C; Patel, Neal R

    2014-01-01

    While neonates account for a significant proportion of health care expenditures related to inpatient care for congenital heart disease, key drivers of resource utilization among this population are poorly defined. Data from 2005 through 2011 were extracted from the Pediatric Health Information System for patients assigned a discharge All Patient Refined Diagnosis Related Group of 630 (neonates with birthweight >2499 g undergoing a major cardiovascular procedure). Mortality risk adjustment for patients undergoing operative interventions was performed with the Risk Adjusment in Congenital Heart Surgery (RACHS-1) score. A total of 13 156 cases were included in the analysis. Despite only a 3% increase in case mix index and no significant change in operative acuity over the study period (RACHS classifications of 3 or greater 67% in 2005 vs. 66% in 2011, P = .64), there were inflation-adjusted increases in both total estimated cost per case of (50% to $151 760 in 2011, P < .001), and mean charge per case (33% to $433 875 in 2011, P < .001). Pharmacy charges increased by 16% (P < .001), with agents including chlorothiazide and albumin accounting for the highest patient charges over the study period. Imaging charges increased by 42% (P < .001), with an average of 5.7 echocardiograms and $6517 in associated charges per case by 2011. While the proportion of patients receiving nitric oxide remained consistent, mean duration of administration increased by 25% to 6.6 days by 2011, accounting for average charges of $52 141 per patient exposed. Among neonates with serious congenital heart disease, increases in both institutional costs and charges to the patient are associated with relatively consistent utilization practices in recent years. Multiinstitutional collaboration may prove useful in aligning evidence-based reductions in practice variation with limitations in resource utilization without compromising the quality of care. © 2013 Wiley Periodicals, Inc.

  15. Trends in Smoking Status and Utilization of Smoking Cessation Agents Among Females with Cardiovascular Diseases.

    PubMed

    Vaidya, Varun; Gangal, Neha S; Shah, Surbhi; Gangan, Nilesh; Bechtol, Robert

    2016-03-01

    In the United States, cigarette smoking accounts for almost 20% of all deaths attributed to heart disease. More women than men die each year of cardiovascular diseases (CVDs). Women who smoke have shown to be at a higher risk of cardiac deaths. The current study aims to determine the trend in smoking prevalence among women with CVD and their utilization of smoking cessation agents from 2004 to 2011. This was a retrospective exploratory study using Medical Expenditure Panel Survey data from 2004 to 2011. All female respondents with any one cardiovascular condition were identified. Descriptive statistics were carried out to obtain the number of female patients with CVD, their smoking status, and their use of smoking cessation agents. Furthermore, disparities in smoking status and smoking cessation agent utilization with respect to race and ethnicity were studied. Among total CVD patients, 53% were females, which corresponded to 25.3 million females in the United States. Around 12.3% among them were current smokers. Only 6.9% among these females used smoking cessation agents. Smoking trends in females were inconsistent throughout the 8 years. Overall, the trend showed a decrease in the percentage of female smokers, while use of smoking cessation agents remained low from 2004 to 2011. Whites and non-Hispanics had more current smokers and women using smoking cessation agents. The eight-year trend shows that the use of smoking cessation agents among females is very low, particularly among non-whites and Hispanics. This is of great concern and future efforts could focus on increasing the utilization of smoking cessation agents and collectively decreasing the risk of smoking in CVD by healthcare professionals.

  16. Utilization of rehabilitation therapy services in Parkinson disease in the United States.

    PubMed

    Fullard, Michelle E; Thibault, Dylan P; Hill, Andrew; Fox, Joellyn; Bhatti, Danish E; Burack, Michelle A; Dahodwala, Nabila; Haberfeld, Elizabeth; Kern, Drew S; Klepitskava, Olga S; Urrea-Mendoza, Enrique; Myers, Phillip; Nutt, Jay; Rafferty, Miriam R; Schwalb, Jason M; Shulman, Lisa M; Willis, Allison W

    2017-09-12

    To examine rehabilitation therapy utilization for Parkinson disease (PD). We identified 174,643 Medicare beneficiaries with a diagnosis of PD in 2007 and followed them through 2009. The main outcome measures were annual receipt of physical therapy (PT), occupational therapy (OT), or speech therapy (ST). Outpatient rehabilitation fee-for-service use was low. In 2007, only 14.2% of individuals with PD had claims for PT or OT, and 14.6% for ST. Asian Americans were the highest users of PT/OT (18.4%) and ST (18.4%), followed by Caucasians (PT/OT 14.4%, ST 14.8%). African Americans had the lowest utilization (PT/OT 7.8%, ST 8.2%). Using logistic regression models that accounted for repeated measures, we found that African American patients (adjusted odds ratio [AOR] 0.63 for PT/OT, AOR 0.63 for ST) and Hispanic patients (AOR 0.97 for PT/OT, AOR 0.91 for ST) were less likely to have received therapies compared to Caucasian patients. Patients with PD with at least one neurologist visit per year were 43% more likely to have a claim for PT evaluation as compared to patients without neurologist care (AOR 1.43, 1.30-1.48), and this relationship was similar for OT evaluation, PT/OT treatment, and ST. Geographically, Western states had the greatest use of rehabilitation therapies, but provider supply did not correlate with utilization. This claims-based analysis suggests that rehabilitation therapy utilization among older patients with PD in the United States is lower than reported for countries with comparable health care infrastructure. Neurologist care is associated with rehabilitation therapy use; provider supply is not. © 2017 American Academy of Neurology.

  17. Satellite imaging and vector-borne diseases: the approach of the French National Space Agency (CNES).

    PubMed

    Marechal, Fabienne; Ribeiro, Nathalie; Lafaye, Murielle; Güell, Antonio

    2008-11-01

    Tele-epidemiology consists in studying human and animal epidemic, the spread of which is closely tied to environmental factors, using data from earth-orbiting satellites. By combining various data originated from satellites such as SPOT (vegetation indexes), Meteosat (winds and cloud masses) and other Earth observation data from Topex/Poseidon and Envisat (wave height, ocean temperature and colour) with hydrology data (number and distribution of lakes, water levels in rivers and reservoirs) and clinical data from humans and animals (clinical cases and serum use), predictive mathematical models can be constructed. A number of such approaches have been tested in the last three years. In Senegal, for example, Rift Valley fever epidemics are being monitored using a predictive model based on the rate at which water holes dry out after the rainy season, which affects the number of mosquito eggs which carry the virus.

  18. Clinical utility of serologic testing for celiac disease in ontario: an evidence-based analysis.

    PubMed

    2010-01-01

    negatives may occur in IgA-deficient individuals. The incidence and prevalence of celiac disease in the general population and in subjects with symptoms consistent with or at higher risk of celiac disease based on systematic reviews published in 2004 and 2009 are summarized below. ADULTS OR MIXED POPULATION: 1 to 17/100,000/year 2 to 51/100,000/yearIn one of the studies, a stratified analysis showed that there was a higher incidence of celiac disease in younger children compared to older children, i.e., 51 cases/100,000/year in 0 to 2 year-olds, 33/100,000/year in 2 to 5 year-olds, and 10/100,000/year in children 5 to 15 years old. The prevalence of celiac disease reported in population-based studies identified in the 2004 systematic review varied between 0.14% and 1.87% (median: 0.47%, interquartile range: 0.25%, 0.71%). According to the authors of the review, the prevalence did not vary by age group, i.e., adults and children. Type 1 diabetes (adults and children): 1 to 11%AUTOIMMUNE THYROID DISEASE: 2.9 to 3.3%FIRST DEGREE RELATIVES OF PATIENTS WITH CELIAC DISEASE: 2 to 20% PREVALENCE OF CELIAC DISEASE IN SUBJECTS WITH SYMPTOMS CONSISTENT WITH THE DISEASE: The prevalence of celiac disease in subjects with symptoms consistent with the disease varied widely among studies, i.e., 1.5% to 50% in adult studies, and 1.1% to 17% in pediatric studies. Differences in prevalence may be related to the referral pattern as the authors of a systematic review noted that the prevalence tended to be higher in studies whose population originated from tertiary referral centres compared to general practice. What is the sensitivity and specificity of serologic tests in the diagnosis celiac disease?What is the clinical validity of serologic tests in the diagnosis of celiac disease? The clinical validity was defined as the ability of the test to change diagnosis.What is the clinical utility of serologic tests in the diagnosis of celiac disease? The clinical utility was defined as the impact of

  19. Simulation of the water regime for a vast agricultural region territory utilizing measurements from polar-orbital and geostationary meteorological satellites

    NASA Astrophysics Data System (ADS)

    Muzylev, Eugene; Uspensky, Alexander; Startseva, Zoya; Volkova, Elena; Kukharsky, Alexander; Uspensky, Sergey

    2013-04-01

    The model of land surface-atmosphere interaction has been developed to calculate the water and heat balance components for vast vegetation covered areas during the growing season. The model is adjusted to utilize estimates of the land surface and meteorological characteristics derived from satellite-based measurements of radiometers AVHRR/NOAA, MODIS/EOS Terra, Aqua, and SEVIRI/Meteosat-9. The studies have been conducted for the territory of the European Russia Central Black Earth Region (CCR) with area of 227,300 km2 comprising seven regions of the Russian Federation for years 2009-2012 vegetation seasons. The technologies of AVHRR and MODIS data thematic processing have been refined and adapted to the study region providing the retrieval of land surface temperature Tls and emissivity E, land-air temperature (temperature at vegetation cover level) Ta, normalized difference vegetation index NDVI, vegetation cover fraction B, as well as the leaf area index LAI. The updated linear regression estimators for Tls, Ta and LAI have been built using more representative training samples compiled for the above vegetation seasons. The updated software package has been applied for AVHRR data processing to generate named remote sensing products for various dates of the mentioned vegetation periods. On the base of special technology and Internet resources the remote sounding products (Tls, E, NDVI, LAI), derived from MODIS data and covering the CCR, have been downloaded from LP DAAC web-site for the same vegetation seasons. The new method and technology have been developed and adopted for the retrieval of Tls and E from SEVIRI data. The retrievals cover the region of interest and are produced at daylight and nighttime. Method provides the derivation of Tls and E from SEVIRI measurements carried out at three successive times (for example, at 11.00, 12.00, 13.00 UTC), classified as 100% cloud-free for the study region without accurate a priori knowledge of E. The validation of

  20. Clinical Utility of a Precision Medicine Test Evaluating Outpatients with Suspected Obstructive Coronary Artery Disease.

    PubMed

    Ladapo, Joseph A; Budoff, Matt; Sharp, David; Zapien, Michael; Huang, Lin; Maniet, Bruce; Herman, Lee; Monane, Mark

    2017-04-01

    Identifying patients with obstructive coronary artery disease can be challenging for primary care physicians. Advances in precision medicine may help augment clinical tools and redefine the paradigm for evaluating coronary artery disease in the outpatient setting. A blood-based age/sex/gene expression score (ASGES) incorporating key features of precision medicine has shown clinical validity with a 96% negative predictive value and 89% sensitivity in estimating a symptomatic patient's current likelihood of obstructive coronary artery disease. To better characterize the clinical utility of the ASGES and measure its impact on clinician decision-making, a community-based registry was established. The prospective PRESET Registry (NCT01677156) enrolled stable, nonacute adult patients presenting with typical or atypical symptoms suggestive of obstructive coronary artery disease from 21 US primary care practices from August 2012 to August 2014. Demographics, clinical characteristics, and ASGES results (predefined as low [ASGES ≤15] or elevated [ASGES >15]) were collected, as were referrals to Cardiology or further functional/anatomic cardiac testing after ASGES testing. Patients were followed for 1 year post ASGES testing. Among the 566-patient cohort (median age 56 years), clinicians referred 26/252 (10%) of patients with low scores vs 137/314 (44%) of patients with elevated scores to Cardiology or advanced cardiac testing for further evaluation (unadjusted odds ratio 0.15, P <.0001; adjusted odds ratio after accounting for clinical covariates = 0.18, P <.0001). Data on 84 patients referred for advanced cardiac testing showed abnormal findings in 0 of 13 (0%) low ASGES and 10 of 71 (14%) elevated ASGES patients. Major adverse cardiovascular events and revascularization were noted in 3/252 (1.2%) patients with low ASGES and 14/314 (4.5%) patients with elevated ASGES score (P <.03). In this community-based cardiovascular registry, the ASGES demonstrated clinical utility

  1. Diagnostic Utility of Interleukin-6 Expression by Immunohistochemistry in Differentiating Castleman Disease Subtypes and Reactive Lymphadenopathies.

    PubMed

    Post, Ginell R; Bell, Robert C; Rjoop, Anwar; Lobo, Rodolfo Henrich; Yuan, Youzhong; Post, Steven R

    2016-09-01

    The objective of the study was to evaluate the expression pattern of interleukin-6 (IL-6) to determine its utility in differentiating Castleman Disease subtypes and reactive lymphadenopathies. Paraffin-embedded tissue blocks from 20 cases referred for assessment of Castleman Disease (CD) and 4 cases of reactive hyperplasia were selected for immunohistochemical staining with an IL-6 antibody. Six pathologists evaluated the hematoxylin and eosin stained tissue sections and IL-6 expression pattern. Of 20 CD referral cases, the pathologic diagnosis was CD in 14 cases and included 6 hyaline-vascular (HV-CD), 6 plasma cell (PC-CD) and 2 "mixed type"-CD cases. The remaining 6 referral cases showed morphologic features consistent with reactive lymphadenopathy. Patients with non-CD, reactive lymphadenopathies had clinical and/or laboratory features of systemic lupus erythematosus, Hashimoto's disease, viral infection or chronic cellulitis. The pattern of IL-6 expression differed between CD subtypes and non-CD cases. In PC-CD, IL-6 expression was detected in plasma cells and vascular endothelial cells; whereas IL-6 immunoreactivity was detected primarily in vascular endothelial cells in HV-CD. Interfollicular plasma cells were prominent in PC-CD and reactive lymphadenopathies; however, IL-6 expression was significantly increased in PC-CD compared to reactive lymph nodes. Together with morphologic features, the expression pattern of IL-6 detected by immunohistochemistry is helpful to distinguish CD subtypes and reactive mimics. © 2016 by the Association of Clinical Scientists, Inc.

  2. Cost-utility of a disease management program for patients with asthma.

    PubMed

    Steuten, Lotte; Palmer, Stephen; Vrijhoef, Bert; van Merode, Frits; Spreeuwenberg, Cor; Severens, Hans

    2007-01-01

    The long-term cost-utility of a disease management program (DMP) for adults with asthma was assessed compared to usual care. A DMP for patients with asthma has been developed and implemented in the region of Maastricht (The Netherlands). By integrating care, the program aims to continuously improve quality of care within existing budgets. A clinical trial was performed over a period of 15 months to collect data on costs and effects of the program and usual care. These data were used to inform a probabilistic decision-analytic model to estimate the 5-year impact of the program beyond follow-up. A societal perspective was adopted, with outcomes assessed in terms of costs per quality-adjusted life-year (QALY). The DMP is associated with a gain in QALYs compared to usual care (2.7+/-.2 versus 3.4+/-.8), at lower costs (3,302+/-314 euro versus 2,973+/-304 euro), thus leading to dominance. The probability that disease management is the more cost-effective strategy is 76 percent at a societal willingness to pay (WTP) for an additional QALY of 0 euro, reaching 95 percent probability at a WTP of 1,000 euro per additional QALY. Organizing health care according to the principles of disease management for adults with asthma has a high probability of being cost-effective and is associated with a gain in QALYs at lower costs.

  3. The antioxidative function, preventive action on disease and utilization of proanthocyanidins.

    PubMed

    Ariga, Toshiaki

    2004-01-01

    Proanthocyanidins, which belong to a class of polyphenols, are widely distributed throughout the plant kingdom. Most people ingest trace amounts of proanthocyanidins through foods such as red wine and cranberry juice. However, the functional properties of proanthocyanidins have been little understood. Since 1983, we have studied the antioxidative functions, preventive actions on diseases and utilization of proanthocyanidins. The antioxidative activities of proanthocyanidins were found to be much stronger than vitamin C or vitamin E in aqueous systems. The mechanisms for their antioxidative actions were shown to involve radical scavenging, quenching, and enzyme-inhibiting actions. The preventive actions of proanthcyanidins on diseases relating to reactive oxygen species was examined using animal tests. Proanthocyanidin-rich grape seed extract was showed to have preventive actions on diseases such as atherosclerosis, gastric ulcer, large bowel cancer, cataracts and diabetes. In human intervention trials, grape seed extract was shown to have preventive effects on the increase in lipid peroxides in human plasma after exercise and on muscle fatigue after training. The uses and manufacturing techniques of proanthocyanidin products were subsequently developed. The products were launched as antioxidants in food additives, ingredients in nutritional supplements, and cosmetics.

  4. A preliminary study of psychiatric, familial, and medical characteristics of high-utilizing sickle cell disease patients.

    PubMed

    Carroll, Patrick C; Haywood, Carlton; Hoot, Michelle R; Lanzkron, Sophie

    2013-04-01

    To identify demographic, medical, and psychosocial characteristics that distinguished sickle cell disease (SCD) patients who were frequent utilizers of urgent or emergent care resources from low-utilizing patients. Patients at a large urban comprehensive SCD treatment center were recruited from clinic or during urgent care visits. Participants who were high utilizers, defined as having >4 acute or emergency care visits in the prior 12 months, were compared with patients with more typical utilization patterns on lifetime complications of SCD, family background, psychiatric history, occupational function, coping, depressive symptoms, and personality. High utilizers were nearly a decade younger on average; despite this they had a similar lifetime history of SCD complications. High-utilizing patients' parents seemed to have greater educational achievement overall. High utilizers reported a nearly 3-fold greater prevalence of psychiatric illness in family members than low utilizers. On other measures, including coping strategies, social support, and personality, the 2 groups were comparable. The study strengthens emerging evidence that disease severity, familial factors related to greater parental education, and psychiatric illness are important factors in high care utilization in patients with SCD.

  5. The clinical utility of bivalirudin in patients with coronary artery disease.

    PubMed

    Garner, William L; Linden, Julie A; Chrysant, George S

    2013-03-01

    Bivalirudin, a direct thrombin inhibitor, is an anticoagulant commonly used in invasive cardiology procedures. It has evolved from relative obscurity, as an anticoagulation option only utilized in rare instances of allergy or resistance to heparin products, to the now preferred antithrombotic anticoagulant in the cardiac catheterization laboratory. On the way to displacing unfractionated heparin as the preferred anticoagulant for percutaneous coronary intervention, multiple studies comparing bivalirudin with heparin have consistently shown equivalent ischemic efficacy endpoints (i.e. cardiovascular death, myocardial infarction, etc.), with significant reductions in bleeding. Bleeding has been directly linked to worse hospital outcomes in cardiac patient's undergoing invasive coronary artery revascularization procedures. More recent bivalirudin studies now demonstrate reductions in mortality, which has led to a paradigm shift to bivalirudin as the anticoagulant choice both in elective and emergent coronary procedures. We present the major studies that have brought bivalirudin to the forefront of coronary artery disease, specifically coronary interventional procedures.

  6. The Burden of Narcolepsy Disease (BOND) study: health-care utilization and cost findings.

    PubMed

    Black, Jed; Reaven, Nancy L; Funk, Susan E; McGaughey, Karen; Ohayon, Maurice; Guilleminault, Christian; Ruoff, Chad; Mignot, Emmanuel

    2014-05-01

    The aim of this study was to characterize health-care utilization, costs, and productivity in a large population of patients diagnosed with narcolepsy in the United States. This retrospective, observational study using data from the Truven Health Analytics MarketScan Research Databases assessed 5 years of claims data (2006-2010) to compare health-care utilization patterns, productivity, and associated costs among narcolepsy patients (identified by International Classification of Diseases, Ninth Revision (ICD9) narcolepsy diagnosis codes) versus matched controls. A total of 9312 narcolepsy patients (>18 years of age, continuously insured between 2006 and 2010) and 46,559 matched controls were identified. Compared with controls, narcolepsy subjects had approximately twofold higher annual rates of inpatient admissions (0.15 vs. 0.08), emergency department (ED) visits w/o admission (0.34 vs. 0.17), hospital outpatient (OP) visits (2.8 vs. 1.4), other OP services (7.0 vs. 3.2), and physician visits (11.1 vs. 5.6; all p<0.0001). The rate of total annual drug transactions was doubled in narcolepsy versus controls (26.4 vs. 13.3; p<0.0001), including a 337% and 72% higher usage rate of narcolepsy drugs and non-narcolepsy drugs, respectively (both p<0.0001). Mean yearly costs were significantly higher in narcolepsy compared with controls for medical services ($8346 vs. $4147; p<0.0001) and drugs ($3356 vs. $1114; p<0.0001). Narcolepsy was found to be associated with substantial personal and economic burdens, as indicated by significantly higher rates of health-care utilization and medical costs in this large US group of narcolepsy patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Impact of Renal Disease on Patients with Hepatitis C: A Retrospective Analysis of Disease Burden, Clinical Outcomes, and Health Care Utilization and Cost.

    PubMed

    Solid, Craig A; Peter, Senaka A; Natwick, Tanya; Guo, Haifeng; Collins, Allan J; Arduino, Jean Marie

    2017-01-01

    Few studies explore the magnitude of the disease burden and health care utilization imposed by renal disease among patients with hepatitis C virus (HCV). We aimed to describe the characteristics, outcomes, and health care utilization and costs of patients with HCV with and without renal impairment. This retrospective analysis used 2 administrative claims databases: the US commercially insured population in Truven Health MarketScan® data (aged 20-64 years), and the US Medicare fee-for-service population in the Medicare 20% sample (aged ≥65 years). Baseline characteristics and comorbid conditions were identified from claims during 2011; patients were followed for up to 1 year (beginning January 1, 2012) to identify health outcomes of interest and health care utilization and costs. In the MarketScan and Medicare databases, 35,965 and 10,608 patients with HCV were identified, 8.5 and 26.5% with evidence of renal disease (chronic kidney disease [CKD] or end-stage renal disease [ESRD]). Most comorbid conditions and unadjusted outcome rates increased across groups from patients with no evidence of renal disease to non-ESRD CKD to ESRD. Health care utilization followed a similar pattern, as did the costs. Our findings suggest that HCV patients with concurrent renal disease have significantly more comorbidity, a higher likelihood of negative health outcomes, and higher health care utilization and costs. © 2017 S. Karger AG, Basel.

  8. Caregiver burden, health utilities and institutional service costs among community-dwelling paients with Alzheimer's disease

    PubMed Central

    Miller, Edward Alan; Rosenheck, Robert A.; Schneider, Lon S.

    2014-01-01

    This study examined the moderating effect of caregiver burden on the relationship between patients’ health status and institutional costs in Alzheimer's disease (AD). Data were obtained on whether 421 community-dwelling patients with AD in the CATIE-AD trial received institutional services in the month preceding baseline and at 3-, 6-, and 9-months follow-up. All participants had a caregiver who lived with or visited them regularly. Outcome variables include hospital, nursing home, residential, and combined institutional costs. Mixed models were employed to estimate the interaction of Health Utility Index (HUI)-III scores (a health status measure) and five measures of caregiver burden. Wherever significant, results indicate that greater caregiver burden weakens the inverse relationship between health utilities and institutional costs, leading to greater costs than would be expected at a given level of health. Altogether 45.0% of the models (9/20) showed this effect (positive coefficient on the burden-HUI interaction term). Interventions should be based on caregiver burden, regardless of care recipient health status, for even seemingly manageable patients may be at heightened risk for institutionalization if caregivers experience sufficiently high levels of burden. PMID:20625266

  9. A haemophilia disease management programme targeting cost and utilization of specialty pharmaceuticals.

    PubMed

    Duncan, N; Roberson, C; Lail, A; Donfield, S; Shapiro, A

    2014-07-01

    The high cost of clotting factor concentrate (CFC) used to treat haemophilia and von Willebrand disease (VWD) attracts health plans' attention for cost management strategies such as disease management programmes (DMPs). In 2004, Indiana's high risk insurance health plan, the Indiana Comprehensive Health Insurance Association, in partnership with the Indiana Hemophilia and Thrombosis Center developed and implemented a DMP for beneficiaries with bleeding disorders. This report evaluates the effectiveness of the DMP 5 years post implementation, with specific emphasis on the cost of CFC and other medical expenditures by severity of disease. A pre/post analysis was used. The main evaluation measures were total cost, total outpatient CFC IU dispensed and adjusted total outpatient CFC cost. Summary statistics and mean and median plots were calculated. Overall, 1000 non-parametric bootstrap replicates were created and percentile confidence limits for 95% confidence intervals (CI) are reported. Mean emergency department (ED) visits and mean and median duration of hospitalizations are also reported. The DMP was associated with a significant decrease in mean annualized total cost including decreased CFC utilization and cost in most years in the overall group, and specifically in patients with severe haemophilia. Patients with mild and moderate haemophilia contributed little to overall programme expenditures. This specialty health care provider-administered DMP exemplifies the success of targeted interventions developed and implemented through a health care facility expert in the disease state to curb the cost of specialty pharmaceuticals in conditions when their expenditures represent a significant portion of total annual costs of care. © 2014 John Wiley & Sons Ltd.

  10. Clinical utility of the 6-min walk test for patients with moderate Parkinson's disease.

    PubMed

    Kobayashi, Eiji; Himuro, Nobuaki; Takahashi, Mitsuhiko

    2017-03-01

    The aim of this study was to test the clinical utility of the 6-min walk test (6MWT) for patients with moderate Parkinson's disease (PD) through a determination of factors related to this test. This was a descriptive, observational study carried out at a General Hospital, in-patients. Twenty-four patients with moderate PD were studied. We used Hoehn and Yahr stage ratings (HY stage), Unified Parkinson Disease Rating Scales (UPDRS) motor examination score, 6MWT, Berg Balance scale, Timed 'Up & Go' test (TUG), 10-m walk test (10-m walk speed, 10-m walk steps and cadence), and the energy cost of walking (Ec). The average HY stage was 3.1±0.5 and 6MWT was 340.8±110.9 m. TUG (r=-0.68, P<0.01) and Ec (r=-0.65, P<0.01) were correlated significantly with 6MWT. Multiple regression analysis with age, HY stage, TUG, cadence, and Ec as variables indicated a significant degree of variability in the 6MWT results (R=0.77, P<0.001). The TUG (β=-0.47, P<0.01) and Ec (β=-0.4, P<0.01) were correlated independently with the 6MWT results. In contrast, age, HY stage, and cadence were not independently correlated. The 6MWT is a simple tool for assessing walking capacity for patients with PD. In this study, we confirmed the convergent validity and clinical utility of the 6MWT for patients with moderate PD. The 6MWT is useful for clinical assessment to guide the planning of rehabilitation treatment for patients with moderate PD.

  11. Impact of Disease Management on Utilization and Adherence With Drugs and Tests

    PubMed Central

    Thiebaud, Patrick; Demand, Michael; Wolf, Scott A.; Alipuria, Linda L.; Ye, Qin; Gutierrez, Peter R.

    2008-01-01

    OBJECTIVE—The purpose of this study was to evaluate the effect of telephonic care management within a diabetes disease management program on adherence to treatment with hypoglycemic agents, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), statins, and recommended laboratory tests in a Medicaid population. RESEARCH DESIGN AND METHODS—A total of 2,598 patients with diabetes enrolled for at least 2 years in Florida: A Healthy State (FAHS), a large Medicaid disease management program, who received individualized telephonic care management were selected if they were eligible for at least 12 months before and 12 months after beginning care management. Patients were matched one-to-one on all baseline characteristics to 2,598 control patients. The impact of care management on utilization and adherence rates for diabetes-related medications and tests was analyzed with the difference-in-difference estimator. RESULTS—Changes in utilization were evaluated separately for those who were characterized as adherent to treatment at baseline (“users”) and those who were not (“nonusers”). Both groups achieved significant improvement in adherence between baseline and follow-up. Nonusers increased their overall hypoglycemic use by 0.7 script (P < 0.001), by 0.7 script for ACEIs and statins (both P < 0.001), by 0.8 test for A1C (P < 0.001), and by 0.7 test for lipids (P < 0.001). Users increased hypoglycemic use by 1.5 scripts (P < 0.001) and insulin use by 0.9 script (P < 0.001). CONCLUSIONS—The FAHS telephonic care management intervention effectively induced Medicaid patients with diabetes to begin treatment and improved adherence to oral hypoglycemic agents and recommended tests. It also substantially improved adherence among baseline insulin users. PMID:18523144

  12. Utilizing Field Campaign, Flux Tower, and Satellite Data To Improve Simulated Carbon Fluxes and Pools in The Simple Biosphere Model (SiB4)

    NASA Astrophysics Data System (ADS)

    Haynes, K. D.; Baker, I. T.; Denning, S.; Stockli, R.; Schaefer, K. M.; Lokupitiya, E.

    2012-12-01

    Since terrestrial carbon fluxes and pools cannot be measured directly on regional and global scales, land surface models are an important tool in improving estimates of carbon sources and sinks. A variety of data sets now exist to evaluate land surface models against, which can help isolate shortcomings in the model and identify processes not being properly simulated. A variety of ecological properties are measured and hence can be investigated: above and below ground biomass and carbon pools from field campaigns; carbon fluxes from chambers and flux towers; and remotely sensed tree height, wood pools and leaf area index (LAI). In order to compare against these metrics, the Simple Biosphere Model (SiB4) has been restructured to include land cover heterogeneity, prognostic phenology, and carbon pools. This study presents results from SiB4, focusing on boreal North America and tropical South America. By utilizing data collected from field campaigns (the Boreal Ecosystem-Atmosphere Study, BOREAS, and the Large Scale Biosphere-Atmosphere Experiment in Amazonia, LBA), satellite data (remotely sensed LAI and IceSAT LIDAR measurements), and flux tower measurements, we analyze SiB4 results to help identify and resolve shortcomings and missing processes in the model. Land cover heterogeneity, prognostic phenology, and carbon pools have recently been combined in SiB4; and this study will investigate not only the impacts of these features, but also the overall performance of SiB4 in an effort to help improve terrestrial biogeochemical models and to advance our knowledge of the carbon cycle.

  13. Do Model-Based Studies in Chronic Obstructive Pulmonary Disease Measure Correct Values of Utility? A Meta-Analysis.

    PubMed

    Moayeri, Foruhar; Hsueh, Ya-Seng Arthur; Clarke, Philip; Dunt, David

    2016-06-01

    Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease that has considerable impact on utility-based health-related quality of life. Utility is a key input of many decision analytic models used for economic evaluations. To systematically review COPD-related utilities and to compare these with alternative values used in decision models. The literature review comprised studies that generated utilities for COPD-related stages based on EuroQol five-dimensional questionnaire surveys of patients and of decision models of COPD progression that have been used for economic evaluations. The utility values used in modeling studies and those from the meta-analysis of actual patient-level studies were compared and differences quantified. Twenty decision modeling studies that used utility value as an input parameter were found. Within the same span of publication period, 13 studies involving patient-level utility data were identified and included in the meta-analysis. The estimated mean utility values ranged from 0.806 (95% confidence interval [CI] 0.747-0.866) for stage I to 0.616 (95% CI 0.556-0.676) for stage IV. The utility scores for comparable stages in modeling studies were different (significant difference 0.045 [95% CI 0.041-0.052] for stage III). Modeling studies consistently used higher utility values than the average reported patient-level data. COPD decision analytic models are based on a limited range of utility values that are systematically different from average values estimated using a meta-analysis. A more systematic approach in the application of utility measures in economic evaluation is required to appropriately reflect current literature. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  14. Role and clinical utility of pramipexole extended release in the treatment of early Parkinson's disease.

    PubMed

    Hametner, Eva-Maria; Seppi, Klaus; Poewe, Werner

    2012-01-01

    The aim of this article is to provide a short review of the most relevant pharmacological and clinical data on pramipexole extended release (ER) as well as to address the clinical utility and potential advantages of a once-daily formulation especially in the treatment of early Parkinson's disease (PD). Pramipexole is widely established as a symptomatic treatment in early as well as advanced PD. The development of an ER formulation, with stable pramipexole plasma concentration over 24 hours, now offers a bioequivalent once-daily alternative. Double-blind randomized controlled trials in early and advanced PD, have established noninferiority of pramipexole ER compared with immediate release as well as superiority of both formulations over placebo. The overnight switch from the standard to the once-daily formulation was shown to be successful in >80% of patients without requiring any dose adjustments. Potential benefits of the prolonged-release design, which have not yet been formally demonstrated in the pivotal trial program, include improved compliance and a potential for better symptomatic control, particularly in patients with early disease that can be managed with monotherapy.

  15. Coronary Artery Calcium Assessment in CKD: Utility in Cardiovascular Disease Risk Assessment and Treatment?

    PubMed

    Bashir, Ahmed; Moody, William E; Edwards, Nicola C; Ferro, Charles J; Townend, Jonathan N; Steeds, Richard P

    2015-06-01

    Coronary artery calcification (CAC) is a strong predictor of cardiovascular event rates in the general population, and scoring with multislice computed tomography commonly is used to improve risk stratification beyond clinical variables. CAC is accelerated in chronic kidney disease, but this occurs as a result of 2 distinct pathologic processes that result in medial (arteriosclerosis) and intimal (atherosclerosis) deposition. Although there are data that indicate that very high CAC scores may be associated with increased risk of death in hemodialysis, average CAC scores in most patients are elevated at a level at which discriminatory power may be reduced. There is a lack of data to guide management strategies in these patients based on CAC scores. There are even fewer data available for nondialysis patients, and it is uncertain whether CAC score confers an elevated risk of premature cardiovascular morbidity and mortality in such patients. In this article, we review the evidence regarding the utility of CAC score for noninvasive cardiovascular risk assessment in individuals with chronic kidney disease, using a clinical vignette that highlights some of the limitations in using CAC score and considerations in risk stratification.

  16. Development and Utilization of InDel Markers to Identify Peanut (Arachis hypogaea) Disease Resistance

    PubMed Central

    Liu, Lifeng; Dang, Phat M.; Chen, Charles Y.

    2015-01-01

    Peanut diseases, such as leaf spot and spotted wilt caused by Tomato Spotted Wilt Virus, can significantly reduce yield and quality. Application of marker assisted plant breeding requires the development and validation of different types of DNA molecular markers. Nearly 10,000 SSR-based molecular markers have been identified by various research groups around the world, but less than 14.5% showed polymorphism in peanut and only 6.4% have been mapped. Low levels of polymorphism limit the application of marker assisted selection (MAS) in peanut breeding programs. Insertion/deletion (InDel) markers have been reported to be more polymorphic than SSRs in some crops. The goals of this study were to identify novel InDel markers and to evaluate the potential use in peanut breeding. Forty-eight InDel markers were developed from conserved sequences of functional genes and tested in a diverse panel of 118 accessions covering six botanical types of cultivated peanut, of which 104 were from the U.S. mini-core. Results showed that 16 InDel markers were polymorphic with polymorphic information content (PIC) among InDels ranged from 0.017 to 0.660. With respect to botanical types, PICs varied from 0.176 for fastigiata var., 0.181 for hypogaea var., 0.306 for vulgaris var., 0.534 for aequatoriana var., 0.556 for peruviana var., to 0.660 for hirsuta var., implying that aequatoriana var., peruviana var., and hirsuta var. have higher genetic diversity than the other types and provide a basis for gene functional studies. Single marker analysis was conducted to associate specific marker to disease resistant traits. Five InDels from functional genes were identified to be significantly correlated to tomato spotted wilt virus (TSWV) infection and leaf spot, and these novel markers will be utilized to identify disease resistant genotype in breeding populations. PMID:26617627

  17. Development and Utilization of InDel Markers to Identify Peanut (Arachis hypogaea) Disease Resistance.

    PubMed

    Liu, Lifeng; Dang, Phat M; Chen, Charles Y

    2015-01-01

    Peanut diseases, such as leaf spot and spotted wilt caused by Tomato Spotted Wilt Virus, can significantly reduce yield and quality. Application of marker assisted plant breeding requires the development and validation of different types of DNA molecular markers. Nearly 10,000 SSR-based molecular markers have been identified by various research groups around the world, but less than 14.5% showed polymorphism in peanut and only 6.4% have been mapped. Low levels of polymorphism limit the application of marker assisted selection (MAS) in peanut breeding programs. Insertion/deletion (InDel) markers have been reported to be more polymorphic than SSRs in some crops. The goals of this study were to identify novel InDel markers and to evaluate the potential use in peanut breeding. Forty-eight InDel markers were developed from conserved sequences of functional genes and tested in a diverse panel of 118 accessions covering six botanical types of cultivated peanut, of which 104 were from the U.S. mini-core. Results showed that 16 InDel markers were polymorphic with polymorphic information content (PIC) among InDels ranged from 0.017 to 0.660. With respect to botanical types, PICs varied from 0.176 for fastigiata var., 0.181 for hypogaea var., 0.306 for vulgaris var., 0.534 for aequatoriana var., 0.556 for peruviana var., to 0.660 for hirsuta var., implying that aequatoriana var., peruviana var., and hirsuta var. have higher genetic diversity than the other types and provide a basis for gene functional studies. Single marker analysis was conducted to associate specific marker to disease resistant traits. Five InDels from functional genes were identified to be significantly correlated to tomato spotted wilt virus (TSWV) infection and leaf spot, and these novel markers will be utilized to identify disease resistant genotype in breeding populations.

  18. Retrospective Analysis of Structural Disease Progression in Retinitis Pigmentosa Utilizing Multimodal Imaging.

    PubMed

    Cabral, Thiago; Sengillo, Jesse D; Duong, Jimmy K; Justus, Sally; Boudreault, Katherine; Schuerch, Kaspar; Belfort, Rubens; Mahajan, Vinit B; Sparrow, Janet R; Tsang, Stephen H

    2017-09-04

    In this report, we assess the natural progression rate of retinitis pigmentosa (RP) over an average of three years using spectral-domain optical coherence tomography (SD-OCT) and short wavelength fundus autofluorescence (SW-AF). Measurement of the ellipsoid zone (EZ) line width and hyperautofluorescent ring diameters was performed in 81 patients with RP in a retrospective, longitudinal fashion. Rate of structural disease progression, symmetry between eyes, and test-retest variability were quantified. We observed on average, EZ-line widths decreased by 140 µm (5.2%, p < 0.001) per year, and average horizontal and vertical hyperautofluorescent ring diameters decreased by 149 µm (3.6%, p < 0.001) and 120 µm (3.9%, p < 0.001) per year, respectively. The 95th percentile of this cohort had differences in progression slopes between eyes that were less than 154 µm, 118 µm, and 132 µm for EZ-line width and horizontal and vertical ring diameters, respectively. For all measures except horizontal ring diameter, progression rates were significantly slower at end-stage disease. From our data, we observed a statistically significant progression rate in EZ line width and SW-AF ring diameters over time, verifying the utility of these measurements for disease monitoring purposes. Additionally, calculated differences in progression slopes between eyes may prove useful for investigators evaluating the efficacy of unilateral treatments for RP in clinical trials.

  19. Utility of meibography in the evaluation of meibomian glands morphology in normal and diseased eyelids☆

    PubMed Central

    Alsuhaibani, Adel H.; Carter, Keith D.; Abràmoff, Michael D.; Nerad, Jeffrey A.

    2010-01-01

    Purpose To study the utility of meibography for the morphology of meibomian glands in normal eyelids and in various eyelid diseases. Design A cross-sectional study. Methods A newly designed transilluminator, fitting both the upper along with lower eyelids, and an infrared camera were used to obtain video clips of the meibomian glands for 60 asymptomatic subjects with normal eyelid margin. Parameters studied included, ocular surface, Schirmer test, and tear breakup time (TBUT). The meibomian glands of patients with meibomian glands’ abnormality secondary to infectious, inflammatory, malignant, congenital, or post-radiation therapy disease related etiologies were compared with normal patients. Still pictures were extracted from the video clips to evaluate the meibomian glands for gland dropout and gross morphological changes. Results In normal subjects, meibomian glands appeared to be thinner and longer in the upper eye lids than in the lower eye lids. Gland dropout occured with increased age, more in the lower eye lid and in females. Excessive gland drop out (> 75%) was seen in patients with history of trachoma, Stevens Johnson syndrome, severe blepharitis, and post-radiation for orbital tumors. Variable gland drop out was noticed in patients with floppy eyelid syndrome, and blepharitis. In patients with congenital distichiasis, partial or complete gland drop out at the part of the eyelid margins affected by distichiasis was noticed. Conclusions The newly designed transilluminator permitted the examination of both upper and lower eye lid meibomian glands with minimal discomfort. Evaluating the anatomical changes involving meibomian glands with meibography may help increase our understanding of the meibomian gland-related diseases, monitor the effects of treatment, and provide helpful information for patient education. PMID:23960903

  20. Utilizing Chemical Genomics to Identify Cytochrome b as a Novel Drug Target for Chagas Disease

    PubMed Central

    Khare, Shilpi; Roach, Steven L.; Barnes, S. Whitney; Hoepfner, Dominic; Walker, John R.; Chatterjee, Arnab K.; Neitz, R. Jeffrey; Arkin, Michelle R.; McNamara, Case W.; Ballard, Jaime; Lai, Yin; Fu, Yue; Molteni, Valentina; Yeh, Vince; McKerrow, James H.; Glynne, Richard J.; Supek, Frantisek

    2015-01-01

    Unbiased phenotypic screens enable identification of small molecules that inhibit pathogen growth by unanticipated mechanisms. These small molecules can be used as starting points for drug discovery programs that target such mechanisms. A major challenge of the approach is the identification of the cellular targets. Here we report GNF7686, a small molecule inhibitor of Trypanosoma cruzi, the causative agent of Chagas disease, and identification of cytochrome b as its target. Following discovery of GNF7686 in a parasite growth inhibition high throughput screen, we were able to evolve a GNF7686-resistant culture of T. cruzi epimastigotes. Clones from this culture bore a mutation coding for a substitution of leucine by phenylalanine at amino acid position 197 in cytochrome b. Cytochrome b is a component of complex III (cytochrome bc1) in the mitochondrial electron transport chain and catalyzes the transfer of electrons from ubiquinol to cytochrome c by a mechanism that utilizes two distinct catalytic sites, QN and QP. The L197F mutation is located in the QN site and confers resistance to GNF7686 in both parasite cell growth and biochemical cytochrome b assays. Additionally, the mutant cytochrome b confers resistance to antimycin A, another QN site inhibitor, but not to strobilurin or myxothiazol, which target the QP site. GNF7686 represents a promising starting point for Chagas disease drug discovery as it potently inhibits growth of intracellular T. cruzi amastigotes with a half maximal effective concentration (EC50) of 0.15 µM, and is highly specific for T. cruzi cytochrome b. No effect on the mammalian respiratory chain or mammalian cell proliferation was observed with up to 25 µM of GNF7686. Our approach, which combines T. cruzi chemical genetics with biochemical target validation, can be broadly applied to the discovery of additional novel drug targets and drug leads for Chagas disease. PMID:26186534

  1. Utility of endoscopic retrograde cholangiopancreatography on biliopancreatic diseases in patients with Billroth II-reconstructed stomach

    PubMed Central

    Sakai, Yuji; Tsuyuguchi, Toshio; Mikata, Rintaro; Sugiyama, Harutoshi; Yasui, Shin; Miyazaki, Masaru; Yokosuka, Osamu

    2017-01-01

    AIM To examine the utility of endoscopic retrograde cholangiopancreatography (ERCP) on biliopancreatic diseases in the patients with Billroth II-reconstructed stomach. METHODS For 26 cases of biliopancreatic diseases in patients with Billroth II-reconstructed stomach, ERCP was conducted using a straight-view scope or a retrograde oblique-viewing endoscope. All the cases were patients aiming at selective insertion into the bile duct. One patient aimed at diagnosis, and 25 patients aimed at treatment. The cases in which the endoscope reached the duodenal papilla and anastomosis, and insertion into the bile duct became possible, were considered successful. RESULTS The rate of reaching the duodenal papilla and anastomosis was 84.7% (22/26 patients). Among the cases without reaching the duodenal papilla and anastomosis, there were 2 in which the endoscope did not pass due to tumor-induced duodenal infiltration. In 1 case, the fiber did not reach the duodenal papilla due to long afferent loop. The success rate of insertion into the bile duct in patients in which the endoscope reached the duodenal papilla and anastomosis was 90.9% (20/22 patients), and the success rate of procedures including treatment was 86.3% (19/22 patients). After treatment, mild cholangitis was observed in 1 patient (4.5%, 1/22 patients) but relieved conservatively. No other accidental symptom was observed. CONCLUSION It was considered that the ERCP for biliopancreatic diseases in patients with Billroth II-reconstructed stomach will become a less invasive, safe and useful examination and treatment approach. PMID:28360974

  2. Hodgkin disease and non-Hodgkin lymphomas in children: utilization of radiological modalities

    SciTech Connect

    Cohen, M.D.; Siddiqui, A.; Weetman, R.; Provisor, A.; Coates, T.

    1986-02-01

    If costs of medical care are to be reduced, the choice of which imaging modality to use must be made as carefully as possible. This study was done to show how radiological modalities were used to evaluate patients with Hodgkin disease and non-Hodgkin lymphoma. We kept a record of every radiological study performed on 66 children with both diseases seen in the past 6 1/3 years. The results of these studies were analyzed to see which areas of the body were studied, which imaging modality was used, how frequently the studies were repeated, and how frequently the studies gave abnormal results. Our findings disclosed that radiological studies have been appropriately performed in anatomic regions of the body in which disease is present. New imaging modalities have been introduced, and the use of some of the older modalities has been decreased. With some modalities, such as skeletal survey, liver/spleen scan, whole-lung tomography, contrast studies of the bowel, and excretory urography, utilization is higher than it ought to be in view of the fact that the yield of positive results is low and the information is obtainable in many cases from other more sensitive procedures. These studies should not be performed as a routine on initial evaluation or follow-up of all patients with Hodgkin or non-Hodgkin lymphomas. On initial presentation all patients should undergo chest radiography and CT scanning of both chest and abdomen. A problem area is that the timing of follow-up studies has been somewhat erratic, with some inappropriate studies particularly 3 or 4 years after diagnosis. Too many imaging procedures have probably been done in follow-up of our patients.

  3. Diagnostic and Prognostic Utility of the Synaptic Marker Neurogranin in Alzheimer Disease.

    PubMed

    Tarawneh, Rawan; D'Angelo, Gina; Crimmins, Dan; Herries, Elizabeth; Griest, Terry; Fagan, Anne M; Zipfel, Gregory J; Ladenson, Jack H; Morris, John C; Holtzman, David M

    2016-05-01

    Synaptic loss is an early pathologic substrate of Alzheimer disease (AD). Neurogranin is a postsynaptic neuronal protein that has demonstrated utility as a cerebrospinal fluid (CSF) marker of synaptic loss in AD. To investigate the diagnostic and prognostic utility of CSF neurogranin levels in a large, well-characterized cohort of individuals with symptomatic AD and cognitively normal controls. A cross-sectional and longitudinal observational study of cognitive decline in patients with symptomatic AD and cognitively normal controls was performed. Participants were individuals with a clinical diagnosis of early symptomatic AD and cognitively normal controls who were enrolled in longitudinal studies of aging and dementia at the Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine, from January 21, 2000, through March 21, 2011. Data analysis was performed from November 1, 2013, to March 31, 2015. Correlations between baseline CSF biomarker levels and future cognitive decline in patients with symptomatic AD and cognitively normal controls over time. A total of 302 individuals (mean [SE] age, 73.1 [0.4] years) were included in this study (95 patients [52 women and 43 men] with AD and 207 controls [125 women and 82 men]). The CSF neurogranin levels differentiated patients with early symptomatic AD from controls with comparable diagnostic utility (mean [SE] area under the receiver operating characteristic curve, 0.71 [0.03]; 95% CI, 0.64-0.77) to the other CSF biomarkers. The CSF neurogranin levels correlated with brain atrophy (normalized whole-brain volumes: adjusted r = -0.38, P = .02; hippocampal volumes: adjusted r = -0.36, P = .03; entorhinal volumes: adjusted r = -0.46, P = .006; and parahippocampal volumes: adjusted r = -0.47, P = .005, n = 38) in AD and with amyloid load (r = 0.39, P = .02, n = 36) in preclinical AD. The CSF neurogranin levels predicted future cognitive impairment (adjusted hazard ratio, 1

  4. Diagnostic and Prognostic Utility of the Synaptic Marker Neurogranin in Alzheimer Disease

    PubMed Central

    Tarawneh, Rawan; D’Angelo, Gina; Crimmins, Dan; Herries, Elizabeth; Griest, Terry; Fagan, Anne M.; Zipfel, Gregory J.; Ladenson, Jack H.; Morris, John C.; Holtzman, David M.

    2016-01-01

    IMPORTANCE Synaptic loss is an early pathologic substrate of Alzheimer disease (AD). Neurogranin is a postsynaptic neuronal protein that has demonstrated utility as a cerebrospinal fluid (CSF) marker of synaptic loss in AD. OBJECTIVE To investigate the diagnostic and prognostic utility of CSF neurogranin levels in a large, well-characterized cohort of individuals with symptomatic AD and cognitively normal controls. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional and longitudinal observational study of cognitive decline in patients with symptomatic AD and cognitively normal controls was performed. Participants were individuals with a clinical diagnosis of early symptomatic AD and cognitively normal controls who were enrolled in longitudinal studies of aging and dementia at the Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine, from January 21, 2000, through March 21, 2011. Data analysis was performed from November 1, 2013, to March 31, 2015. MAIN OUTCOMES AND MEASURES Correlations between baseline CSF biomarker levels and future cognitive decline in patients with symptomatic AD and cognitively normal controls overtime. RESULTS A total of 302 individuals (mean [SE] age, 73.1 [0.4] years) were included in this study (95 patients [52 women and 43 men] with AD and 207 controls [125 women and 82 men]). The CSF neurogranin levels differentiated patients with early symptomatic AD from controls with comparable diagnostic utility (mean [SE] area under the receiver operating characteristic curve, 0.71 [0.03]; 95% CI, 0.64–0.77) to the other CSF biomarkers. The CSF neurogranin levels correlated with brain atrophy (normalized whole-brain volumes: adjusted r = −0.38, P = .02; hippocampal volumes: adjusted r = −0.36, P = .03; entorhinal volumes: adjusted r = −0.46, P = .006; and parahippocampal volumes: adjusted r = −0.47, P = .005, n = 38) in AD and with amyloid load (r = 0.39, P = .02, n = 36) in preclinical

  5. Dynamic posturography in Parkinson's disease: diagnostic utility of the "first trial effect".

    PubMed

    Visser, J E; Oude Nijhuis, L B; Janssen, L; Bastiaanse, C M; Borm, G F; Duysens, J; Bloem, B R

    2010-06-30

    Previous dynamic posturography studies demonstrated clear abnormalities in balance responses in Parkinson's disease (PD) patients compared to controls at the group level, but its clinical value in the diagnostic process and fall risk estimation in individual patients leaves for improvement. Therefore, we investigated whether a new approach, focusing on the balance responses to the very first and fully unpractised trial rather than a pooled mean response to a series of balance perturbations, could further improve the diagnostic utility of dynamic posturography. Following the first trial, subjects were exposed to repeated balance perturbations, which also permitted us to investigate the training responses. Fourteen patients with PD and 18 age-matched controls were enrolled, who received a series of multidirectional postural perturbations, induced by support surface rotations. We measured trunk and upper arm kinematics and electromyographic responses, and evaluated group differences at three levels: the postural response to the very first backward perturbation; pooled first and habituated postural responses; and habituation rates. Analysis of the first trial responses yielded similar results as evaluation of the mean response over trials: forward flexion of the trunk induced by backward perturbations was decreased in patients, accompanied by increased muscle responses present. Moreover, trunk movement and muscle activity were equally present in both groups-suggesting a preserved training response in PD patients. Early masseter activity in both groups might be indicative of a startle-like component to the balance response. In terms of diagnostic utility, focusing on the first trial response or habituation rate is no better than analysis of pooled responses to a series of perturbations. The apparently preserved training response in PD patients suggests that balance reactions in PD can be improved by repeated exposure, and this may have implications for future exercise

  6. Clinical Predictors of Diagnostic Testing Utility in the Initial Evaluation of Chronic Kidney Disease

    PubMed Central

    Mendu, Mallika L.; Lundquist, Andrew; Aizer, Ayal A.; Leaf, David E.; Robinson, Emily; Steele, David J.R.; Waikar, Sushrut S.

    2016-01-01

    Aim No evidence-based approach to the evaluation of CKD has been established. We sought to identify clinical criteria to guide a rational diagnostic approach for the initial evaluation of CKD. Methods We conducted a retrospective cohort study of 1,487 patients presenting for initial evaluation of CKD over three years (1/2010–1/2013) to academic nephrology clinics. We utilized the electronic medical record to determine tests ordered, abnormal results, and testing that affected diagnosis and/or management. Diagnostic and management yield of testing was defined as the percentage of tests that affected diagnosis and/or management. High yield for a given test was defined as an increased likelihood of the test affecting diagnosis and/or management. Results We identified clinical criteria predictive of high yield for paraprotein-related testing (one of the following: history of monoclonal disease, high risk of CKD progression, hypercalcemia or hemoglobin <10.6), and clinical criteria predictive of high yield for glomerulonephritis testing (one of the following: abnormal urine sediment, 3+ or greater hematuria or proteinuria >500mg/gm). A prior history of hydronephrosis and renal artery stenosis was predictive of high yield of abnormal renal ultrasound. Higher yield of testing was associated with higher risk progression categories for ANA, SPEP, urine sediment, calcium, PTH, hemoglobin, iron, and ferritin. We estimate that initial CKD evaluation costs range from $28 to $109 million/year in US-Medicare expenditure. Conclusion Numerous tests without significant clinical utility are obtained in initial CKD evaluation. Identifying criteria that can guide diagnostic testing may lead to a more informed and cost-effective approach to evaluation. PMID:26610178

  7. Caregiver burden, health utilities, and institutional service use in Alzheimer’s Disease

    PubMed Central

    Miller, Edward Alan; Rosenheck, Robert A.; Schneider, Lon S.

    2011-01-01

    Objective This study examined the moderating effect of caregiver burden on the relationship between the health status of Alzheimer’s disease (AD) patients and their use of institutional services (i.e., hospitalization, nursing home, and residential care). Methods Data were obtained at baseline and 3-, 6-, and 9-months following study entry on 421 community-dwelling patients with AD in the CATIE-AD trial. The outcome variable includes use of any institutional services. Logistic regression was employed to estimate the interaction of Health Utility Index (HUI)-III score (a general health status measure) at outcome and four concurrent caregiver burden measures. Marginal effects were calculated and plotted using random effects models for observations at multiple time points per individual. Average effects were calculated across all observations using models without random effects. Results Random effects results suggest that caregiver burden weakens the inverse relationship between health utilities and institutional service use, leading to greater likelihood of institutional use than would be expected at a given level of health. This is indicated by positive, significant signs on the HUI-III*caregiver burden interaction when burden is measured using the Caregiver Distress Scale, Beck Depression Inventory (BDI), and Caregiver Assessment Survey (all p<.05). It is reinforced by positive, significant average effects deriving from Caregiver Distress and BDI models without random effects (both p<.10). Results deriving from the Burden Interview Scale, though positive, were non-significant and weak by comparison. Conclusion Caregiver support interventions should be offered to individuals caring for less advanced AD patients. Otherwise healthy patients may be at increased risk for institutionalization when caregivers experience high levels of burden. PMID:21560160

  8. Discovery of temporal and disease association patterns in condition-specific hospital utilization rates

    PubMed Central

    Haimovich, Julian S.; Venkatesh, Arjun K.; Coppi, Andreas; Li, Shu-Xia; Krumholz, Harlan M.

    2017-01-01

    Identifying temporal variation in hospitalization rates may provide insights about disease patterns and thereby inform research, policy, and clinical care. However, the majority of medical conditions have not been studied for their potential seasonal variation. The objective of this study was to apply a data-driven approach to characterize temporal variation in condition-specific hospitalizations. Using a dataset of 34 million inpatient discharges gathered from hospitals in New York State from 2008–2011, we grouped all discharges into 263 clinical conditions based on the principal discharge diagnosis using Clinical Classification Software in order to mitigate the limitation that administrative claims data reflect clinical conditions to varying specificity. After applying Seasonal-Trend Decomposition by LOESS, we estimated the periodicity of the seasonal component using spectral analysis and applied harmonic regression to calculate the amplitude and phase of the condition’s seasonal utilization pattern. We also introduced four new indices of temporal variation: mean oscillation width, seasonal coefficient, trend coefficient, and linearity of the trend. Finally, K-means clustering was used to group conditions across these four indices to identify common temporal variation patterns. Of all 263 clinical conditions considered, 164 demonstrated statistically significant seasonality. Notably, we identified conditions for which seasonal variation has not been previously described such as ovarian cancer, tuberculosis, and schizophrenia. Clustering analysis yielded three distinct groups of conditions based on multiple measures of seasonal variation. Our study was limited to New York State and results may not directly apply to other regions with distinct climates and health burden. A substantial proportion of medical conditions, larger than previously described, exhibit seasonal variation in hospital utilization. Moreover, the application of clustering tools yields groups

  9. Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

    PubMed Central

    Lin, Junji; Li, Yunfeng; Tian, Haijun; Goodman, Michael J; Gabriel, Susan; Nazareth, Tara; Turner, Stuart J; Arcona, Stephen; Kahler, Kristijan H

    2014-01-01

    Background Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for lung infections and other pathologies (eg, pneumonia); however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia. Methods A retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index), and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits), and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching. Results In the baseline cohort (N=467,578), patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years) and had higher Charlson Comorbidity Index scores (3.3 vs 2.6) than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely to have a hospitalization (odds ratio; 95% confidence intervals [CI] =9.2; 8.9, 9.4) and four times more likely to have an ER visit (odds ratio; 95% CI =4.4; 4.3, 4.5) over the 12-month follow-up period compared to the control cohort. The estimated 12-month mean hospitalization costs ($14,353 [95% CI: $14,037–$14,690]), outpatient costs ($6,891 [95% CI: $6,706–$7,070]), and prescription drug costs ($1,104 [95% CI

  10. The effect of disease management on utilization of services by race/ethnicity: evidence from the Florida Medicaid program.

    PubMed

    Kominski, Gerald F; Morisky, Donald E; Afifi, Abdelmonem A; Kotlerman, Jenny B

    2008-03-01

    To measure possible racial/ethnic differences in a Florida disease management (DM) program on utilization of selected healthcare services for 4 chronic illnesses. Pre-post comparison of utilization among 15,275 high-risk beneficiaries enrolled in DM in the Florida Medicaid program between October 2001 and October 2003. Two-part regression analyses of the effect of DM on annualized inpatient days, emergency department (ED) visits, and outpatient visits, controlling for relevant covariates. Annualized rates were used to adjust for differences in length of program enrollment. Disease management patients in the postperiod had significantly lower annual rates of inpatient days, ED visits, and outpatient visits across most racial/ethnic groups. Disease management reduced utilization by a similar absolute amount in each racial/ethnic group. However, baseline disparities in utilization of inpatient days were not reduced by the DM program. Disease management has a similar effect across different racial/ethnic groups but may not ameliorate important baseline disparities. Evaluations of DM programs should account for baseline disparities in utilization and examine whether those disparities can be reduced through DM.

  11. Differential resource utilization benefits with Internet-based care coordination in elderly veterans with chronic diseases associated with high resource utilization.

    PubMed

    Dang, Stuti; Ma, Fangchao; Nedd, Nicole; Aguilar, Enrique J; Roos, Bernard A

    2006-02-01

    Our objective was to evaluate in a demonstration project whether our T-Care Program, telecare management via an Internet-based home-messaging device, reduces resource utilization by patients with congestive heart failure (CHF), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD). Study participants were drawn from a group of high resource-utilizing veterans over age 60 and included 19 patients with CHF, 23 with DM, and 17 with COPD. Data were gathered on hospital admissions, bed days of care (BDOC), outpatient admissions, and emergency department visits 6 months before and 6 months after enrollment in the telecare program. Nonparametric tests examined pre- and postintervention effects. For patients with CHF, significant decreases were found with T-Care in total emergency department visits (30 to 10, p = 0.03) and hospital admissions (20 to 8, p = 0.03). The decrease in BDOC (179 to 53) was not significant (p = 0.07). Outpatient visits were unchanged (71 to 83, p = 0.38). There were no significant changes for patients with COPD: the apparent BDOC decrease (115 to 46) was not significant (p = 0.24). The outpatient visits by patients with DM decreased significantly (199 to 143, p = 0.03), but no significance was found for changes in their emergency department visits, hospital admissions, and BDOC. The apparent BDOC increase (38 to 198, p = 0.23) was related to two patients with extended stays for an amputation and mitral valve surgery. We found that telecare models may reduce resource utilization in elderly patients with chronic diseases, especially in patients with CHF. Because of the small sample size and lack of controls, larger and more carefully designed follow-up trials are needed to determine cost efficiency for different chronic diseases, and the relative value of the interpersonal contact versus the technological components of this care coordination model.

  12. FOCUS: Future of fecal calprotectin utility study in inflammatory bowel disease

    PubMed Central

    Rosenfeld, Greg; Greenup, Astrid-Jane; Round, Andrew; Takach, Oliver; Halparin, Lawrence; Saadeddin, Abid; Ho, Jin Kee; Lee, Terry; Enns, Robert; Bressler, Brian

    2016-01-01

    AIM To evaluate the perspective of gastroenterologists regarding the impact of fecal calprotectin (FC) on the management of patients with inflammatory bowel disease (IBD). METHODS Patients with known IBD or symptoms suggestive of IBD for whom the physician identified that FC would be clinically useful were recruited. Physicians completed an online “pre survey” outlining their rationale for the test. After receipt of the test results, the physicians completed an online “post survey” to portray their perceived impact of the test result on patient management. Clinical outcomes for a subset of patients with follow-up data available beyond the completion of the “post survey” were collected and analyzed. RESULTS Of 373 test kits distributed, 290 were returned, resulting in 279 fully completed surveys. One hundred and ninety patients were known to have IBD; 147 (77%) with Crohn’s Disease, 43 (21%) Ulcerative Colitis and 5 (2%) IBD unclassified. Indications for FC testing included: 90 (32.2%) to differentiate a new diagnosis of IBD from Irritable Bowel Syndrome (IBS), 85 (30.5%) to distinguish symptoms of IBS from IBD in those known to have IBD and 104 (37.2%) as an objective measure of inflammation. FC levels resulted in a change in management 51.3% (143/279) of the time which included a significant reduction in the number of colonoscopies (118) performed (P < 0.001). Overall, 97.5% (272/279) of the time, the physicians found the test sufficiently useful that they would order it again in similar situations. Follow-up data was available for 172 patients with further support for the clinical utility of FC provided. CONCLUSION The FC test effected a change in management 51.3% of the time and receipt of the result was associated with a reduction in the number of colonoscopies performed. PMID:27688663

  13. Inert gas washout: theoretical background and clinical utility in respiratory disease.

    PubMed

    Robinson, Paul D; Goldman, Michael D; Gustafsson, Per M

    2009-01-01

    Inert gas washout was first described more than 60 years ago and 2 principal tests have been developed from it: the single breath and multiple breath washout (MBW) techniques. The invention of fast responding gas analysers almost 60 years ago and small computers 30 years later have facilitated breath-by-breath analysis and the development of sophisticated analysis techniques. It is now possible to detect not only the degree of pulmonary ventilation inhomogeneity, but also to gain important insight into the location of the underlying disease process. While single breath washout requires a full vital capacity effort, tidal breathing during the multiple breath test requires minimal co-operation and co-ordination, and is feasible in subjects of all ages. Available MBW normative data from parameters, such as the lung clearance index, appears to vary minimally with age, making MBW particularly useful to follow children longitudinally. Multiple breath inert gas washout has demonstrated improved sensitivity, in comparison to spirometry, in the early detection of a number of important disease processes, including cystic fibrosis. Despite this, these important techniques remain under-utilised in the clinical setting and there is a lack of commercially available devices currently available. The recent resurgence of research in this area has produced a large number of important studies and a pronounced international interest has developed in these techniques. This review article will provide an overview of the theoretical background of inert gas washout and analysis indices, review important physiological and clinical insights gained from research to date (as well as from our own experience) to illustrate its utility, and outline the challenges that lie ahead in incorporating these techniques into the mainstream clinical setting.

  14. Utility and safety of rituximab in pediatric autoimmune and inflammatory CNS disease

    PubMed Central

    Brilot, Fabienne; Duffy, Lisa V.; Twilt, Marinka; Waldman, Amy T.; Narula, Sona; Muscal, Eyal; Deiva, Kumaran; Andersen, Erik; Eyre, Michael R.; Eleftheriou, Despina; Brogan, Paul A.; Kneen, Rachel; Alper, Gulay; Anlar, Banu; Wassmer, Evangeline; Heineman, Kirsten; Hemingway, Cheryl; Riney, Catherine J.; Kornberg, Andrew; Tardieu, Marc; Stocco, Amber; Banwell, Brenda; Gorman, Mark P.; Benseler, Susanne M.; Lim, Ming

    2014-01-01

    Objective: To assess the utility and safety of rituximab in pediatric autoimmune and inflammatory disorders of the CNS. Methods: Multicenter retrospective study. Results: A total of 144 children and adolescents (median age 8 years, range 0.7–17; 103 female) with NMDA receptor (NMDAR) encephalitis (n = 39), opsoclonus myoclonus ataxia syndrome (n = 32), neuromyelitis optica spectrum disorders (n = 20), neuropsychiatric systemic lupus erythematosus (n = 18), and other neuroinflammatory disorders (n = 35) were studied. Rituximab was given after a median duration of disease of 0.5 years (range 0.05–9.5 years). Infusion adverse events were recorded in 18/144 (12.5%), including grade 4 (anaphylaxis) in 3. Eleven patients (7.6%) had an infectious adverse event (AE), including 2 with grade 5 (death) and 2 with grade 4 (disabling) infectious AE (median follow-up of 1.65 years [range 0.1–8.5]). No patients developed progressive multifocal leukoencephalopathy. A definite, probable, or possible benefit was reported in 125 of 144 (87%) patients. A total of 17.4% of patients had a modified Rankin Scale (mRS) score of 0–2 at rituximab initiation, compared to 73.9% at outcome. The change in mRS 0–2 was greater in patients given rituximab early in their disease course compared to those treated later. Conclusion: While limited by the retrospective nature of this analysis, our data support an off-label use of rituximab, although the significant risk of infectious complications suggests rituximab should be restricted to disorders with significant morbidity and mortality. Classification of evidence: This study provides Class IV evidence that in pediatric autoimmune and inflammatory CNS disorders, rituximab improves neurologic outcomes with a 7.6% risk of adverse infections. PMID:24920861

  15. Routine Paediatric Sickle Cell Disease (SCD) Outpatient Care in a Rural Kenyan Hospital: Utilization and Costs

    PubMed Central

    Amendah, Djesika D.; Mukamah, George; Komba, Albert; Ndila, Carolyne; Williams, Thomas N.

    2013-01-01

    Background More than 70% of children with sickle cell disease (SCD) are born in sub-Saharan Africa where the prevalence at birth of this disease reaches 2% or higher in some selected areas. There is a dearth of knowledge on comprehensive care received by children with SCD in sub-Saharan Africa and its associated cost. Such knowledge is important for setting prevention and treatment priorities at national and international levels. This study focuses on routine care for children with SCD in an outpatient clinic of the Kilifi District Hospital, located in a rural area on the coast of Kenya. Objective To estimate the per-patient costs for routine SCD outpatient care at a rural Kenyan hospital. Methods We collected routine administrative and primary cost data from the SCD outpatient clinic and supporting departments at Kilifi District Hospital, Kenya. Costs were estimated by evaluating inputs - equipment, medication, supplies, building use, utility, and personnel - to reflect the cost of offering this service within an existing healthcare facility. Annual economic costs were similarly calculated based on input costs, prorated lifetime of equipment and appropriate discount rate. Sensitivity analyses evaluated these costs under different pay scales and different discount rate. Results We estimated that the annual economic cost per patient attending the SCD clinic was USD 138 in 2010 with a range of USD 94 to USD 229. Conclusion This study supplies the first published estimate of the cost of routine outpatient care for children born with SCD in sub-Saharan Africa. Our study provides policy makers with an indication of the potential future costs of maintaining specialist outpatient clinics for children living with SCD in similar contexts. PMID:23593408

  16. Utility and safety of rituximab in pediatric autoimmune and inflammatory CNS disease.

    PubMed

    Dale, Russell C; Brilot, Fabienne; Duffy, Lisa V; Twilt, Marinka; Waldman, Amy T; Narula, Sona; Muscal, Eyal; Deiva, Kumaran; Andersen, Erik; Eyre, Michael R; Eleftheriou, Despina; Brogan, Paul A; Kneen, Rachel; Alper, Gulay; Anlar, Banu; Wassmer, Evangeline; Heineman, Kirsten; Hemingway, Cheryl; Riney, Catherine J; Kornberg, Andrew; Tardieu, Marc; Stocco, Amber; Banwell, Brenda; Gorman, Mark P; Benseler, Susanne M; Lim, Ming

    2014-07-08

    To assess the utility and safety of rituximab in pediatric autoimmune and inflammatory disorders of the CNS. Multicenter retrospective study. A total of 144 children and adolescents (median age 8 years, range 0.7-17; 103 female) with NMDA receptor (NMDAR) encephalitis (n = 39), opsoclonus myoclonus ataxia syndrome (n = 32), neuromyelitis optica spectrum disorders (n = 20), neuropsychiatric systemic lupus erythematosus (n = 18), and other neuroinflammatory disorders (n = 35) were studied. Rituximab was given after a median duration of disease of 0.5 years (range 0.05-9.5 years). Infusion adverse events were recorded in 18/144 (12.5%), including grade 4 (anaphylaxis) in 3. Eleven patients (7.6%) had an infectious adverse event (AE), including 2 with grade 5 (death) and 2 with grade 4 (disabling) infectious AE (median follow-up of 1.65 years [range 0.1-8.5]). No patients developed progressive multifocal leukoencephalopathy. A definite, probable, or possible benefit was reported in 125 of 144 (87%) patients. A total of 17.4% of patients had a modified Rankin Scale (mRS) score of 0-2 at rituximab initiation, compared to 73.9% at outcome. The change in mRS 0-2 was greater in patients given rituximab early in their disease course compared to those treated later. While limited by the retrospective nature of this analysis, our data support an off-label use of rituximab, although the significant risk of infectious complications suggests rituximab should be restricted to disorders with significant morbidity and mortality. This study provides Class IV evidence that in pediatric autoimmune and inflammatory CNS disorders, rituximab improves neurologic outcomes with a 7.6% risk of adverse infections. © 2014 American Academy of Neurology.

  17. Limited Diagnostic Utility of Plasma Adrenocorticotropic Hormone for Differentiation between Adrenal Cushing Syndrome and Cushing Disease.

    PubMed

    Hong, A Ram; Kim, Jung Hee; Hong, Eun Shil; Kim, I Kyeong; Park, Kyeong Seon; Ahn, Chang Ho; Kim, Sang Wan; Shin, Chan Soo; Kim, Seong Yeon

    2015-09-01

    Measurement of the plasma adrenocorticotropic hormone (ACTH) level has been recommended as the first diagnostic test for differentiating between ACTH-independent Cushing syndrome (CS) and ACTH-dependent CS. When plasma ACTH values are inconclusive, a differential diagnosis of CS can be made based upon measurement of the serum dehydroepiandrosterone sulfate (DHEA-S) level and results of the high-dose dexamethasone suppression test (HDST). The aim of this study was to assess the utility of plasma ACTH to differentiate adrenal CS from Cushing' disease (CD) and compare it with that of the HDST results and serum DHEA-S level. We performed a retrospective, multicenter study from January 2000 to May 2012 involving 92 patients with endogenous CS. The levels of plasma ACTH, serum cortisol, 24-hour urine free cortisol (UFC) after the HDST, and serum DHEA-S were measured. Fifty-seven patients had adrenal CS and 35 patients had CD. The area under the curve of plasma ACTH, serum DHEA-S, percentage suppression of serum cortisol, and UFC after HDST were 0.954, 0.841, 0.950, and 0.997, respectively (all P<0.001). The cut-off values for plasma ACTH, percentage suppression of serum cortisol, and UFC after HDST were 5.3 pmol/L, 33.3%, and 61.6%, respectively. The sensitivity and specificity of plasma ACTH measurement were 84.2% and 94.3%, those of serum cortisol were 95.8% and 90.6%, and those of UFC after the HDST were 97.9% and 96.7%, respectively. Significant overlap in plasma ACTH levels was seen between patients with adrenal CS and those with CD. The HDST may be useful in differentiating between these forms of the disease, especially when the plasma ACTH level alone is not conclusive.

  18. Cost-utility of biological treatment sequences for luminal Crohn's disease in Europe.

    PubMed

    Rencz, Fanni; Gulácsi, László; Péntek, Márta; Gecse, Krisztina B; Dignass, Axel; Halfvarson, Jonas; Gomollón, Fernando; Baji, Petra; Peyrin-Biroulet, Laurent; Lakatos, Peter L; Brodszky, Valentin

    2017-04-28

    This study aims to compare the cost-effectiveness of treatment sequences with available biologics, including adalimumab (ADA), biosimilar infliximab (bsIFX), originator infliximab (IFX) and vedolizumab (VEDO) for luminal Crohn's disease in nine European countries. A Markov-model was constructed to simulate five-year medical costs and quality-adjusted life years (QALYs). Data on clinical efficacy were obtained from randomised controlled trials. Country-specific unit costs, discount rates and a third-party payer perspective were applied. The bsIFX versus conventional therapy resulted in the most favourable incremental cost-utility ratios (ICURs) ranging from €34,580 (Hungary) to €77,062/QALY (Sweden). Compared to bsIFX, the bsIFX-ADA sequence was more cost-effective than the bsIFX-VEDO sequence with ICURs varying between €70,277 (France) and €162,069/QALY (Germany). The ICURs of the bsIFX-ADA-VEDO sequence versus the bsIFX-ADA strategy were between €206,266 (The Netherlands) and €363,232/QALY (Spain). We are the first to compare cost-effectiveness of multiple biological sequences for luminal Crohn's disease. Based on our findings, bsIFX can be recommended as a first-line treatment in patients unresponsive to conventional treatments. While biological sequences only slightly differ in their associated health gains, their costs vary greatly. The bsIFX-ADA-VEDO seems to be the most cost-effective sequence of the available biologics across Europe.

  19. A global network for the control of snail-borne disease using satellite surveillance and geographic information systems.

    PubMed

    Malone, J B; Bergquist, N R; Huh, O K; Bavia, M E; Bernardi, M; El Bahy, M M; Fuentes, M V; Kristensen, T K; McCarroll, J C; Yilma, J M; Zhou, X N

    2001-04-27

    At a team residency sponsored by the Rockefeller Foundation in Bellagio, Italy, 10-14 April 2000 an organizational plan was conceived to create a global network of collaborating health workers and earth scientists dedicated to the development of computer-based models that can be used for improved control programs for schistosomiasis and other snail-borne diseases of medical and veterinary importance. The models will be assembled using GIS methods, global climate model data, sensor data from earth observing satellites, disease prevalence data, the distribution and abundance of snail hosts, and digital maps of key environmental factors that affect development and propagation of snail-borne disease agents. A work plan was developed for research collaboration and data sharing, recruitment of new contributing researchers, and means of access of other medical scientists and national control program managers to GIS models that may be used for more effective control of snail-borne disease. Agreement was reached on the use of compatible GIS formats, software, methods and data resources, including the definition of a 'minimum medical database' to enable seamless incorporation of results from each regional GIS project into a global model. The collaboration plan calls for linking a 'central resource group' at the World Health Organization, the Food and Agriculture Organization, Louisiana State University and the Danish Bilharziasis Laboratory with regional GIS networks to be initiated in Eastern Africa, Southern Africa, West Africa, Latin America and Southern Asia. An Internet site, www.gnosisGIS.org, (GIS Network On Snail-borne Infections with special reference to Schistosomiasis), has been initiated to allow interaction of team members as a 'virtual research group'. When completed, the site will point users to a toolbox of common resources resident on computers at member organizations, provide assistance on routine use of GIS health maps in selected national disease control

  20. High-resolution shipboard measurements of phytoplankton: a way forward for enhancing the utility of satellite SST and chlorophyll for mapping microscale features and frontal zones in coastal waters

    NASA Astrophysics Data System (ADS)

    Jenkins, Christy A.; Goes, Joaquim I.; McKee, Kali; Gomes, Helga do R.; Arnone, Robert; Wang, Menghua; Ondrusek, Michael; Nagamani, P. V.; Preethi Latha, T.; Rao, K. H.; Dadhwal, V. K.

    2016-05-01

    Coastal eddies, frontal zones and microscale oceanographic features are now easily observable from satellite measurements of SST and Chl a. Enhancing the utility of these space-borne measurements for biological productivity, biogeochemical cycling and fisheries investigations will require novel bio-optical methods capable of providing information on the community structure, biomass and photo-physiology of phytoplankton associated on spatial scales that match these features. This study showcases high-resolution in-situ measurements of sea water hydrography (SeaBird CTD®), CDOM (WetLabs ALF®), phytoplankton functional types (PFTs, FlowCAM®), biomass (bbe Moldaenke AlgaeOnlineAnalyzer® and WetLabs ALF®) and phytoplankton photosynthetic competency (mini-FIRe) across microscale features encountered during a recent (Nov. 2014) cruise in support of NOAA's VIIRS ocean color satellite calibration and validation activities. When mapped against binned daily, Level 2 satellite images of Chl a, Kd490 and SST over the cruise period, these high-resolution in-situ data showed great correspondence with the satellite data, but more importantly allowed for identification of PFTs and water types associated with microscale features. Large assemblages of phytoplankton communities comprising of diatoms and diatom-diazotroph associations (DDAs), were found in mesohaline frontal zones. Despite their high biomass, these populations were characterized by low photosynthetic competency, indicative of a bloom at the end of its active growth possibly due to nitrogen depletion in the water. Other prominent PFTs such as Trichodesmium spp., Synechococcus spp. and cryptophytes, were also associated with specific water masses offering the promise and potential that ocean remote sensing reflectance bands when examined in the context of water types also measurable from space, could greatly enhance the utility of satellite measurements for biological oceanographic, carbon cycling and fisheries

  1. Synergistic Utilization of Microwave Satellite Data and GRACE-Total Water Storage Anomaly for Improving Available Water Capacity Prediction in Lower Mekong Basin

    NASA Astrophysics Data System (ADS)

    Gupta, M.; Bolten, J. D.; Lakshmi, V.

    2015-12-01

    The Mekong River is the longest river in Southeast Asia and the world's eighth largest in discharge with draining an area of 795,000 km² from the eastern watershed of the Tibetan Plateau to the Mekong Delta including three provinces of China, Myanmar, Lao PDR, Thailand, Cambodia and Viet Nam. This makes the life of people highly vulnerable to availability of the water resources as soil moisture is one of the major fundamental variables in global hydrological cycles. The day-to-day variability in soil moisture on field to global scales is an important quantity for early warning systems for events like flooding and drought. In addition to the extreme situations the accurate soil moisture retrieval are important for agricultural irrigation scheduling and water resource management. The present study proposes a method to determine the effective soil hydraulic parameters directly from information available for the soil moisture state from the recently launched SMAP (L-band) microwave remote sensing observations. Since the optimized parameters are based on the near surface soil moisture information, further constraints are applied during the numerical simulation through the assimilation of GRACE Total Water Storage (TWS) within the physically based land surface model. This work addresses the improvement of available water capacity as the soil hydraulic parameters are optimized through the utilization of satellite-retrieved near surface soil moisture. The initial ranges of soil hydraulic parameters are taken in correspondence with the values available from the literature based on FAO. The optimization process is divided into two steps: the state variable are optimized and the optimal parameter values are then transferred for retrieving soil moisture and streamflow. A homogeneous soil system is considered as the soil moisture from sensors such as AMSR-E/SMAP can only be retrieved for the top few centimeters of soil. To evaluate the performance of the system in helping

  2. School absenteeism, health status, and health care utilization among children with asthma: associations with parental chronic disease.

    PubMed

    Lipstein, Ellen A; Perrin, James M; Kuhlthau, Karen A

    2009-01-01

    Parents with chronic disease may be more likely than healthy parents to perceive their children with chronic conditions as medically vulnerable. Our objective for this study was to determine if children with asthma whose parents have chronic disease differ in health care utilization, school absenteeism, and reported child health status compared with those whose parents do not have chronic disease. We selected children with asthma, 5 to 17 years of age, and their parents from the 2003 National Health Interview Survey. We determined whether parents had chronic disease and examined associations of parental chronic disease with child health status, school absenteeism, and health care utilization. We controlled for factors known to influence our dependent variables, including an indicator of child disease severity, in multivariable regression. Among 561 parent-child dyads, children with asthma whose parents had chronic disease were more likely to have less than very good health and missed an average of 1.3 more school days annually than other children with asthma. Among children with less severe asthma, those whose parents had chronic disease had lower reported health status but did not miss more school (mean difference: 0.39) than children whose parents did not have chronic disease. Having a parent with chronic disease was not associated with increased health care utilization. Compared with other children with asthma, children whose parents have chronic disease have worse health status and miss more school, particularly among children with more severe asthma. Understanding how parents' health influences children's health care and health status may help providers work with parents to more effectively and efficiently manage their children's asthma care so they can more fully participate in school and other activities.

  3. Satellite Tracking System

    NASA Technical Reports Server (NTRS)

    1991-01-01

    Researchers at the Center for Aerospace Sciences of the University of North Dakota (UND), Grand Forks, used three NASA Computer programs (SANDTRACKS, ODG, NORAD) to develop a Satellite Tracking System for real time utilization of TIROS weather/environment satellite information. SANDTRACKS computes the satellite's position relative to the Earth. ODG allows plotting a view of Earth as seen by the satellite. NORAD computes sight direction, visibility times and maximum elevation angle during each orbit. With the system, UND's Earth System Science Institute will be able to routinely monitor agricultural and environmental conditions of the Northern Plains.

  4. Obesity in the Workplace: Impact on Cardiovascular Disease, Cost, and Utilization of Care

    PubMed Central

    Colombi, Alberto M.; Wood, G. Craig

    2011-01-01

    Background In forecasting the future of cardiovascular disease (CVD), the American Heart Association calls for preventive strategies with particular attention to obesity. The association between obesity and CVD, including coronary artery disease (CAD) and diabetes, is well established. The rising prevalence of obesity in the workforce may have additional implications for employers and employees besides the demonstrated effects on absenteeism and workers' compensation. Objective This study was undertaken to determine the impact of population obesity on care utilization and cost of cardiovascular conditions such as hypertension, CAD, and cerebrovascular disease (or stroke) in a large US population of employees engaged in a major corporate wellness program. Study sample Using data from a single large industrial employer across 29 geographically distinct worksites in the United States, 179,708 episodes of care from 2004 to 2007 for 10,853 employees were included. Methods The population-based economic impact of obesity was calculated on the basis of the frequency of episodes of care per 1000 employees and on the amount eligible for payment per episode of care in US dollars. Data were obtained from a wellness program databases, episode of illness inventories, and pharmacy and medical claims. High and low prevalence rates of obesity, by obesity quartile, were used to create linear mixed models to examine associations with disease outcomes, while controlling for correlation within each worksite. Results Worksites with a high rate of obesity (ie, in the fourth quartile) had 348.4 more episodes of care of any kind per 1000 employees (P <.001), 38.6 more hypertension episodes of care per 1000 employees (P <.001), and 2.5 more cerebrovascular disease episodes of care per 1000 employees (P = .017) compared with worksites in the lower 3 quartiles. A worksite in the fourth obesity rate quartile had $223 greater cost per any kind of episode (P <.001), $169 greater cost per

  5. The clinical utility of basophil activation testing in diagnosis and monitoring of allergic disease.

    PubMed

    Hoffmann, H J; Santos, A F; Mayorga, C; Nopp, A; Eberlein, B; Ferrer, M; Rouzaire, P; Ebo, D G; Sabato, V; Sanz, M L; Pecaric-Petkovic, T; Patil, S U; Hausmann, O V; Shreffler, W G; Korosec, P; Knol, E F

    2015-11-01

    The basophil activation test (BAT) has become a pervasive test for allergic response through the development of flow cytometry, discovery of activation markers such as CD63 and unique markers identifying basophil granulocytes. Basophil activation test measures basophil response to allergen cross-linking IgE on between 150 and 2000 basophil granulocytes in <0.1 ml fresh blood. Dichotomous activation is assessed as the fraction of reacting basophils. In addition to clinical history, skin prick test, and specific IgE determination, BAT can be a part of the diagnostic evaluation of patients with food-, insect venom-, and drug allergy and chronic urticaria. It may be helpful in determining the clinically relevant allergen. Basophil sensitivity may be used to monitor patients on allergen immunotherapy, anti-IgE treatment or in the natural resolution of allergy. Basophil activation test may use fewer resources and be more reproducible than challenge testing. As it is less stressful for the patient and avoids severe allergic reactions, BAT ought to precede challenge testing. An important next step is to standardize BAT and make it available in diagnostic laboratories. The nature of basophil activation as an ex vivo challenge makes it a multifaceted and promising tool for the allergist. In this EAACI task force position paper, we provide an overview of the practical and technical details as well as the clinical utility of BAT in diagnosis and management of allergic diseases.

  6. Clinical utility of platinum chromium bare-metal stents in coronary heart disease

    PubMed Central

    Jorge, Claudia; Dubois, Christophe

    2015-01-01

    Coronary stents represent a key development for the treatment of obstructive coronary artery disease since the introduction of percutaneous coronary intervention. While drug-eluting stents gained wide acceptance in contemporary percutaneous coronary intervention practice, further developments in bare-metal stents remain crucial for patients who are not candidates for drug-eluting stents, or to improve metallic platforms for drug elution. Initially, stent platforms used biologically inert stainless steel, restricting stent performance due to limitations in flexibility and strut thickness. Later, cobalt chromium stent alloys outperformed steel as the material of choice for stents, allowing latest generation stents to be designed with significantly thinner struts, while maintaining corrosion resistance and radial strength. Most recently, the introduction of the platinum chromium alloy refined stent architecture with thin struts, high radial strength, conformability, and improved radiopacity. This review will provide an overview of the novel platinum chromium bare-metal stent platforms available for coronary intervention. Mechanical properties, clinical utility, and device limitations will be summarized and put into perspective. PMID:26345228

  7. Utility of the functional activities questionnaire for distinguishing mild cognitive impairment from very mild Alzheimer disease.

    PubMed

    Teng, Edmond; Becker, Brian W; Woo, Ellen; Knopman, David S; Cummings, Jeffrey L; Lu, Po H

    2010-01-01

    Current criteria for mild cognitive impairment (MCI) require "essentially intact" performance of activities of daily living (ADLs), which has proven difficult to operationalize. We sought to determine how well the Functional Activities Questionnaire (FAQ), a standardized assessment of instrumental ADLs, delineates the clinical distinction between MCI and very mild Alzheimer disease (AD). We identified 1801 individuals in the National Alzheimer's Coordinating Center Uniform Data Set with MCI (n=1108) or very mild AD (n=693) assessed with the FAQ and randomized them to the development or test sets. Receiver-operator curve (ROC) analysis of the development set identified optimal cut-points that maximized the sensitivity and specificity of FAQ measures for differentiating AD from MCI and were validated with the test set. ROC analysis of total FAQ scores in the development set produced an area under the curve of 0.903 and an optimal cut-point of 5/6, which yielded 80.3% sensitivity, 87.0% specificity, and 84.7% classification accuracy in the test set. Bill paying, tracking current events, and transportation (P's<0.005) were the FAQ items of greatest diagnostic utility. These data suggest that the FAQ exhibits adequate sensitivity and specificity when used as a standardized assessment of instrumental ADLs in the diagnosis of AD versus MCI.

  8. Utility of expanded polystyrene (EPS) beads in the control of vector-borne diseases.

    PubMed

    Sivagnaname, N; Amalraj, D Dominic; Mariappan, T

    2005-10-01

    The use of chemicals or bio-larvicides for the control of Culex quinquefasciatus and Anopheles stephensi breeding in pit latrines and overhead tanks (OHT) respectively is discouraged owing to many undesirable impacts in the environment. Due to faecal contamination and poor survival, use of predatory fish in OHTs is not feasible. The use of expanded polystyrene (EPS) beads is a potential alternative in these habitats. EPS beads not only prevent oviposition but also kill the immature by forming a thick blanket on the water surface. A thick layer of 2 cm with beads of 2 mm is sufficient to suppress and prevent mosquito breeding. These are cheap, environmentally safe and do not need frequent application since they remain on the surface for quiet a long time. Successful trials against C. quinquefasciatus breeding in pit latrines, soakage pits, septic tanks, etc., have been carried out in Kenya, Zimbabwe and Tanzania. Certain trials with EPS indicated reduction in microfilaria (mf) rate besides decline in biting density. In India, EPS beads have also been used on small scale for the control of A. stephensi and A. culicifacies breeding in OHTs and unused wells respectively. The polystyrene beads have also been reported to be effective in the control of mosquito breeding in biogas plants and other industrial situations. The practical utility of EPS beads in the control of vector-borne diseases has been discussed in the present review.

  9. Health Care Utilization and Attitudes Survey: Understanding Diarrheal Disease in Rural Gambia

    PubMed Central

    Saha, Debasish; Akinsola, Adebayo; Sharples, Katrina; Adeyemi, Mitchell O.; Antonio, Martin; Imran, Sayeed; Jasseh, Momodou; Hossain, Mohammad J.; Nasrin, Dilruba; Kotloff, Karen L.; Levine, Myron M.; Hill, Philip C.

    2013-01-01

    Diarrheal disease causes ∼1.34 million deaths per year among children under 5 years of age globally. We conducted a Health Care Utilization and Attitudes Survey of 1,012 primary caregivers of children aged 0–11, 12–23, and 24–59 months randomly selected from a Demographic Surveillance population in rural Gambia. Point prevalence of diarrhea was 7.7% (95% confidence interval [CI] = 6.1–9.8); 23.3% had diarrhea within the previous 2 weeks. Caregivers of 81.5% of children with diarrhea sought healthcare outside their home, but only 48.4% of them visited a health center. Only 17.0% (95% CI = 12.1–23.2) of children with diarrhea received oral rehydration solution (ORS) at home. Abbreviated surveys conducted on six occasions over the subsequent 2 years showed no change in prevalence or treatment-seeking behavior. Diarrhea remains a significant problem in rural young Gambian children. Encouraging care-seeking behavior at health centers and promoting ORS use can reduce mortality and morbidity in this population. PMID:23629926

  10. Health Care Utilization and Attitudes Survey: understanding diarrheal disease in rural Gambia.

    PubMed

    Saha, Debasish; Akinsola, Adebayo; Sharples, Katrina; Adeyemi, Mitchell O; Antonio, Martin; Imran, Sayeed; Jasseh, Momodou; Hossain, Mohammad J; Nasrin, Dilruba; Kotloff, Karen L; Levine, Myron M; Hill, Philip C

    2013-07-01

    Diarrheal disease causes ∼1.34 million deaths per year among children under 5 years of age globally. We conducted a Health Care Utilization and Attitudes Survey of 1,012 primary caregivers of children aged 0-11, 12-23, and 24-59 months randomly selected from a Demographic Surveillance population in rural Gambia. Point prevalence of diarrhea was 7.7% (95% confidence interval [CI] = 6.1-9.8); 23.3% had diarrhea within the previous 2 weeks. Caregivers of 81.5% of children with diarrhea sought healthcare outside their home, but only 48.4% of them visited a health center. Only 17.0% (95% CI = 12.1-23.2) of children with diarrhea received oral rehydration solution (ORS) at home. Abbreviated surveys conducted on six occasions over the subsequent 2 years showed no change in prevalence or treatment-seeking behavior. Diarrhea remains a significant problem in rural young Gambian children. Encouraging care-seeking behavior at health centers and promoting ORS use can reduce mortality and morbidity in this population.

  11. Utility of the advanced chronic kidney disease patient management tools: case studies.

    PubMed

    Patwardhan, Meenal B; Matchar, David B; Samsa, Gregory P; Haley, William E

    2008-01-01

    Appropriate management of advanced chronic kidney disease (CKD) delays or limits its progression. The Advanced CKD Patient Management Toolkit was developed using a process-improvement technique to assist patient management and address CKD-specific management issues. We pilot tested the toolkit in 2 community nephrology practices, assessed the utility of individual tools, and evaluated the impact on conformance to an advanced CKD guideline through patient chart abstraction. Tool use was distinct in the 2 sites and depended on the site champion's involvement, the extent of process reconfiguration demanded by a tool, and its perceived value. Baseline conformance varied across guideline recommendations (averaged 54%). Posttrial conformance increased in all clinical areas (averaged 59%). Valuable features of the toolkit in real-world settings were its ability to: facilitate tool selection, direct implementation efforts in response to a baseline performance audit, and allow selection of tool versions and customizing them. Our results suggest that systematically created, multifaceted, and customizable tools can promote guideline conformance.

  12. Estimating health service utilization for treatment of pneumococcal disease: the case of Brazil.

    PubMed

    Sartori, A M C; Novaes, C G; de Soárez, P C; Toscano, C M; Novaes, H M D

    2013-07-02

    Health service utilization (HSU) is an essential component of economic evaluations of health initiatives. Defining HSU for cases of pneumococcal disease (PD) is particularly complex considering the varying clinical manifestations and diverse severity. We describe the process of developing estimates of HSU for PD as part of an economic evaluation of the introduction of pneumococcal conjugate vaccine in Brazil. Nationwide inpatient and outpatient HSU by children under-5 years with meningitis (PM), sepsis (PS), non-meningitis non-sepsis invasive PD (NMNS), pneumonia, and acute otitis media (AOM) was estimated. We assumed that all cases of invasive PD (PM, PS, and NMNS) required hospitalization. The study perspective was the health system, including both the public and private sectors. Data sources were obtained from national health information systems, including the Hospital Information System (SIH/SUS) and the Notifiable Diseases Information System (SINAN); surveys; and community-based and health care facility-based studies. We estimated hospitalization rates of 7.69 per 100,000 children under-5 years for PM (21.4 for children <1 years of age and 4.3 for children aged 1-4 years), 5.89 for PS (20.94 and 2.17), and 4.01 for NMNS (5.5 and 3.64) in 2004, with an overall hospitalization rate of 17.59 for all invasive PD (47.27 and 10.11). The estimated incidence rate of all-cause pneumonia was 93.4 per 1000 children under-5 (142.8 for children <1 years of age and 81.2 for children aged 1-4 years), considering both hospital and outpatient care. Secondary data derived from health information systems and the available literature enabled the development of national HSU estimates for PD in Brazil. Estimating HSU for noninvasive disease was challenging, particularly in the case of outpatient care, for which secondary data are scarce. Information for the private sector is lacking in Brazil, but estimates were possible with data from the public sector and national population

  13. Linking Satellite Remote Sensing Based Environmental Predictors to Disease: AN Application to the Spatiotemporal Modelling of Schistosomiasis in Ghana

    NASA Astrophysics Data System (ADS)

    Wrable, M.; Liss, A.; Kulinkina, A.; Koch, M.; Biritwum, N. K.; Ofosu, A.; Kosinski, K. C.; Gute, D. M.; Naumova, E. N.

    2016-06-01

    90% of the worldwide schistosomiasis burden falls on sub-Saharan Africa. Control efforts are often based on infrequent, small-scale health surveys, which are expensive and logistically difficult to conduct. Use of satellite imagery to predictively model infectious disease transmission has great potential for public health applications. Transmission of schistosomiasis requires specific environmental conditions to sustain freshwater snails, however has unknown seasonality, and is difficult to study due to a long lag between infection and clinical symptoms. To overcome this, we employed a comprehensive 8-year time-series built from remote sensing feeds. The purely environmental predictor variables: accumulated precipitation, land surface temperature, vegetative growth indices, and climate zones created from a novel climate regionalization technique, were regressed against 8 years of national surveillance data in Ghana. All data were aggregated temporally into monthly observations, and spatially at the level of administrative districts. The result of an initial mixed effects model had 41% explained variance overall. Stratification by climate zone brought the R2 as high as 50% for major zones and as high as 59% for minor zones. This can lead to a predictive risk model used to develop a decision support framework to design treatment schemes and direct scarce resources to areas with the highest risk of infection. This framework can be applied to diseases sensitive to climate or to locations where remote sensing would be better suited than health surveys.

  14. Utilizing NASA EOS, European Remote Sensing Satellites (ERS-1 & 2), and ENVISAT (Environmental Satellite) to Create a Methodology for Monitoring Marine Debris Dispersal to Coastal Areas by Examining the Gulf of Mexico Loop Current

    NASA Astrophysics Data System (ADS)

    Reahard, R. R.; Albin, A.; Barrett, S.; Brooks, C.; Lee, L.; Mallett, C.; Pezold, B.

    2011-12-01

    The goal of this project is to apply satellite data to model surface circulation in the Gulf of Mexico as a means to aid in the monitoring of marine debris dispersal and the regulation of marine debris practices. Marine debris is a persistent problem for coastal areas throughout the world. In the Gulf of Mexico, the Loop Current flows north through the Yucatan Channel, loops east, then south, exiting through the Florida Straits. Clockwise-rotating areas of warm water, known as eddies, periodically separate from the Loop Current. These eddies have the potential to trap and transport debris onto shores, such as the Padre Island National Seashore. The latter is a 68 mile long barrier island beach in southeastern Texas, and is the longest undeveloped beach in the world. This naturally formed beach can accumulate up to one ton of marine debris per linear mile. This project used sea surface height and height anomaly data based on NASA RADAR altimeter satellites TOPEX/Poseidon, Jason 1, and Jason 2; as well as European RADAR altimeters onboard ERS-1, ERS-2 (European Remote Sensing Satellite), and ENVISAT (Environmental Satellite). This project also employed MODIS sea surface temperature (SST) data to aid in monitoring and visualizing the Loop Current. The sea surface height and height anomaly data were processed to calculate geostrophic flow velocities and predict particle paths. This research provided NOAA's Marine Debris Program and the Padre Island National Seashore with a better understanding of how the Loop Current and surface circulation patterns disperse marine debris to the region. A methodology to monitor Gulf of Mexico surface circulation and predict particle paths by using RADAR altimeter data were provided to partnering agencies. The project provided maps of debris trajectories and geostrophic currents that demonstrate the usefulness of satellite altimetry data to monitor oceanographic processes which in turn affect the distribution of marine debris.

  15. Satellite Communication.

    ERIC Educational Resources Information Center

    Technology Teacher, 1985

    1985-01-01

    Presents a discussion of communication satellites: explains the principles of satellite communication, describes examples of how governments and industries are currently applying communication satellites, analyzes issues confronting satellite communication, links mathematics and science to the study of satellite communication, and applies…

  16. Satellite Communication.

    ERIC Educational Resources Information Center

    Technology Teacher, 1985

    1985-01-01

    Presents a discussion of communication satellites: explains the principles of satellite communication, describes examples of how governments and industries are currently applying communication satellites, analyzes issues confronting satellite communication, links mathematics and science to the study of satellite communication, and applies…

  17. The utility of alizarin red s staining in calcium pyrophosphate dihydrate crystal deposition disease.

    PubMed

    Yamakawa, Koji; Iwasaki, Hiroshi; Masuda, Ikuko; Ohjimi, Yuko; Honda, Itsuo; Saeki, Kazuhiko; Zhang, Jingfan; Shono, Eisuke; Naito, Masatoshi; Kikuchi, Masahiro

    2003-05-01

    To determine the most suitable staining method for preservation and detection of calcium pyrophosphate dihydrate (CPPD) crystals in histological sections of patients with CPPD crystal deposition disease. Paraffin sections of CPPD crystal-bearing tissues of 31 patients were stained with hematoxylin and eosin (H&E) and Alizarin red S (ARS). For H&E, the sections were treated with Mayer's hematoxylin (pH 2.3) for 5 min and with eosin alcohol (pH 4.1) for 1 min. For ARS, 1% ARS dissolved in distilled water was adjusted to pH 6.4 by adding 0.1% ammonia solution drop by drop while stirring. As controls, unstained sections were soaked in 1% citric acid monohydrate solution (CAMS, pH 2.3) for 5 or 10 min. The histological preparations were examined under a compensated polarized light using a first-order red compensator. We counted the number of weakly positive birefringent CPPD crystals in 3 high power fields (HPF, 0.272 mm2). CPPD crystals were seen clearly in most specimens stained with ARS, but were markedly reduced in tissue sections stained with H&E or CAMS. The number of CPPD crystals detected in sections stained by ARS (1723 +/- 683 per 3 HPF, mean +/- standard deviation) was significantly higher compared with H&E, CAMS (5 min), and CAMS (10 min) (401 +/- 374, 1022 +/- 616, and 494 +/- 636 per 3 HPF, respectively; p < 0.001, each). Standard H&E staining reduces the number of visible CPPD crystals, probably due to the strong acidity of both hematoxylin and eosin solutions, whereas the ARS stain seems to preserve a large number of CPPD crystals. The utility of ARS staining may improve the identification of CPPD crystals and contribute to a correct diagnosis of CPPD crystal deposition.

  18. Suicide loss, changes in medical care utilization, and hospitalization for cardiovascular disease and diabetes mellitus.

    PubMed

    Cho, Jaelim; Jung, Sang Hyuk; Kim, Changsoo; Suh, Mina; Choi, Yoon Jung; Sohn, Jungwoo; Cho, Seong-Kyung; Suh, Il; Shin, Dong Chun; Rexrode, Kathryn M

    2016-03-01

    The impact of suicide loss on family members' cardiometabolic health has little been evaluated in middle-aged and elderly people. We investigated the effect of suicide loss on risks for cardiovascular disease (CVD) and diabetes mellitus (DM) in suicide completers' family members using a national representative comparison group. The study subjects were 4253 family members of suicide completers and 9467 non-bereaved family members of individuals who were age and gender matched with the suicide completers in the Republic of Korea. National health insurance data were used to identify medical care utilization during the year before and after a suicide loss. A recurrent-events survival analysis was performed to estimate the hazard ratios (HRs) of hospitalizations for CVD, DM, or psychiatric disorders, after adjusting for age, residence, and socioeconomic status. Among subjects without a past history of CVD, DM, or psychiatric disorders, the increased risks of recurrent hospitalizations were observed for CVD [HR 1.343, 95% confidence interval (CI) 1.001-1.800 in men; HR 1.240, 95% CI 1.025-1.500 in women] and DM (HR 2.238, 95% CI 1.379-3.362 in men; HR 1.786, 95% CI 1.263-2.527 in women). In subjects with a past history of CVD, DM, or psychiatric disorders, the number of medical care visits decreased after a suicide loss, and suicide completers' family members showed lower rates of hospitalization for CVD and DM than the comparison group. Compared with non-bereaved family members, suicide completers' family members without a past history of CVD, DM, or psychiatric disorder showed a high risk of hospitalization for those conditions. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  19. Prognostic Utility of Secretory Phospholipase A2 in Patients with Stable Coronary Artery Disease

    PubMed Central

    O’Donoghue, Michelle; Mallat, Ziad; Morrow, David A; Benessiano, Joelle; Sloan, Sarah; Omland, Torbjørn; Solomon, Scott D.; Braunwald, Eugene; Tedgui, Alain; Sabatine, Marc S

    2011-01-01

    Background Secretory phospholipase A2 (sPLA2) may contribute to atherogenesis. To date, few prospective studies have examined the utility of sPLA2 for risk stratification in coronary artery disease (CAD). Methods Plasma sPLA2 activity was measured at baseline in 3708 subjects in the PEACE randomized trial of trandolapril versus placebo in stable CAD. Median follow-up was 4.8 years. Cox regression was used to adjust for demographics, clinical risk factors, apolipoprotein B, apolipoprotein A1, and medications. Results After multivariable adjustment, sPLA2 was associated with an increased risk of cardiovascular death, myocardial infarction or stroke (adjusted hazard ratio quartile 4:quartile 1 1.55, 95% CI 1.13–2.14) and cardiovascular death or heart failure (adjusted hazard ratio quartile 4:quartile 1 1.91, 95% CI 1.20–3.03). In further multivariable assessment, increased activities of sPLA2 were associated with the risk of cardiovascular death, myocardial infarction or stroke (adjusted hazard ratio 1.47, 95% CI 1.06–2.04) independent of lipoprotein-associated phospholipase A2 mass and C-reactive protein, and modestly improved the area under the curve (AUC) beyond established clinical risk factors (AUC 0.668 to 0.675, P=0.01). sPLA2, NT-pro B-type natriuretic peptide and high-sensitivity cardiac troponin T were all independently associated with cardiovascular death or heart failure and each improved risk discrimination (P=0.02, P<0.001, P<0.001, respectively). Conclusion sPLA2 activity provides independent prognostic information beyond established risk markers in patients with stable CAD. These data are encouraging for studies designed to evaluate the role of sPLA2 as a therapeutic target. PMID:21784767

  20. Flavonoids, cognition, and dementia: actions, mechanisms, and potential therapeutic utility for Alzheimer disease.

    PubMed

    Williams, Robert J; Spencer, Jeremy P E

    2012-01-01

    There is increasing evidence that the consumption of flavonoid-rich foods can beneficially influence normal cognitive function. In addition, a growing number of flavonoids have been shown to inhibit the development of Alzheimer disease (AD)-like pathology and to reverse deficits in cognition in rodent models, suggestive of potential therapeutic utility in dementia. The actions of flavonoid-rich foods (e.g., green tea, blueberry, and cocoa) seem to be mediated by the direct interactions of absorbed flavonoids and their metabolites with a number of cellular and molecular targets. For example, their specific interactions within the ERK and PI3-kinase/Akt signaling pathways, at the level of receptors or kinases, have been shown to increase the expression of neuroprotective and neuromodulatory proteins and increase the number of, and strength of, connections between neurons. Concurrently, their effects on the vascular system may also lead to enhancements in cognitive performance through increased brain blood flow and an ability to initiate neurogenesis in the hippocampus. Additional mechanisms have been suggested for the ability of flavonoids to delay the initiation of and/or slow the progression of AD-like pathology and related neurodegenerative disorders, including a potential to inhibit neuronal apoptosis triggered by neurotoxic species (e.g., oxidative stress and neuroinflammation) or disrupt amyloid β aggregation and effects on amyloid precursor protein processing through the inhibition of β-secretase (BACE-1) and/or activation of α-secretase (ADAM10). Together, these processes act to maintain the number and quality of synaptic connections in key brain regions and thus flavonoids have the potential to prevent the progression of neurodegenerative pathologies and to promote cognitive performance.

  1. Insurance Coverage and Utilization at a Sexually Transmitted Disease Clinic in a Medicaid Expansion State.

    PubMed

    Montgomery, Madeline C; Raifman, Julia; Nunn, Amy S; Bertrand, Thomas; Uvin, A Ziggy; Marak, Theodore; Comella, Jaime; Almonte, Alexi; Chan, Philip A

    2017-05-01

    In Rhode Island, the Patient Protection and Affordable Care Act has led to over 95% of the state's population being insured. We evaluated insurance coverage and barriers to insurance use among patients presenting for services at the Rhode Island sexually transmitted disease (STD) clinic. We analyzed factors associated with insurance coverage and utilization among patients presenting for STD services between July and December 2015. A total of 692 patients had insurance information available; of those, 40% were uninsured. Patients without insurance were more likely than those with insurance to be nonwhite (50% among uninsured, compared with 40% among insured; P = 0.014) and Hispanic or Latino/a (25%, compared with 16%; P = 0.006), and less likely to be men who have sex with men (27%, compared with 39%; P = 0.001). Of those with health insurance, 26% obtained coverage as a result of the Affordable Care Act, and 56% of those were previously uninsured. Among uninsured individuals, barriers to obtaining health insurance included cost and unemployment. Among those with insurance, 43% reported willingness to use insurance for STD services. Barriers to insurance use included concerns about anonymity and out-of-pocket costs. Despite expanded insurance access, many individuals presenting to the Rhode Island STD Clinic were uninsured. Among those who were insured, significant barriers still existed to using insurance. STD clinics continue to play an important role in providing safety-net STD services in states with low uninsured rates. Both public and private insurers are needed to address financial barriers and optimize payment structures for services.

  2. Utilization of ERTS data to detect plant diseases and nutrient deficiencies, soil types and moisture levels

    NASA Technical Reports Server (NTRS)

    Parks, W. L. (Principal Investigator); Sewell, J. I.; Hilty, J. W.; Rennie, J. C.

    1973-01-01

    The author has identified the following significant results. Findings demonstrate the feasibility of delineating major terrain features, land uses, and crop species through computerized analyses. Channel 6 appears to give the most information for making separations of this type. By enlarging satellite imagery and visually comparing this with high altitude aerial photographs, locating small terrain features and cropland areas on satellite imagery is greatly facilitated. Forest types are discernable on the 2402 imagery with a #25 filter: pine stands have dark tones, hardwood stands have light tones, and pine-hardwood have intermediate tones. No textural differences are evident on this type of imagery. However, on the 2424 imagery with #89B filter, textural differences are evident but tonal differences are absent. Areas of considerable texture are interpreted as stands of high volume while areas of suppressed texture are of low volume. The 2402 imagery with a #57 filter appears to have little information of importance in timber inventory.

  3. Landscape characterization of peridomestic risk for Lyme disease using satellite imagery

    NASA Technical Reports Server (NTRS)

    Dister, S. W.; Fish, D.; Bros, S. M.; Frank, D. H.; Wood, B. L.

    1997-01-01

    Remotely sensed characterizations of landscape composition were evaluated for Lyme disease exposure risk on 337 residential properties in two communities of suburban Westchester County, New York. Properties were categorized as no, low, or high risk based on seasonally adjusted densities of Ixodes scapularis nymphs, determined by drag sampling during June and July 1990. Spectral indices based on Landsat Thematic Mapper data provided relative measures of vegetation structure and moisture (wetness), as well as vegetation abundance (greenness). A geographic information system (GIS) was used to spatially quantify and relate the remotely sensed landscape variables to risk category. A comparison of the two communities showed that Chappaqua, which had more high-risk properties (P < 0.001), was significantly greener and wetter than Armonk (P < 0.001). Furthermore, within Chappaqua, high-risk properties were significantly greener and wetter than lower-risk properties in this community (P < 0.01). The high-risk properties appeared to contain a greater proportion of broadleaf trees, while lower-risk properties were interpreted as having a greater proportion of nonvegetative cover and/or open lawn. The ability to distinguish these fine scale differences among communities and individual properties illustrates the efficiency of a remote sensing/GIS-based approach for identifying peridomestic risk of Lyme disease over large geographic areas.

  4. Landscape characterization of peridomestic risk for Lyme disease using satellite imagery

    NASA Technical Reports Server (NTRS)

    Dister, S. W.; Fish, D.; Bros, S. M.; Frank, D. H.; Wood, B. L.

    1997-01-01

    Remotely sensed characterizations of landscape composition were evaluated for Lyme disease exposure risk on 337 residential properties in two communities of suburban Westchester County, New York. Properties were categorized as no, low, or high risk based on seasonally adjusted densities of Ixodes scapularis nymphs, determined by drag sampling during June and July 1990. Spectral indices based on Landsat Thematic Mapper data provided relative measures of vegetation structure and moisture (wetness), as well as vegetation abundance (greenness). A geographic information system (GIS) was used to spatially quantify and relate the remotely sensed landscape variables to risk category. A comparison of the two communities showed that Chappaqua, which had more high-risk properties (P < 0.001), was significantly greener and wetter than Armonk (P < 0.001). Furthermore, within Chappaqua, high-risk properties were significantly greener and wetter than lower-risk properties in this community (P < 0.01). The high-risk properties appeared to contain a greater proportion of broadleaf trees, while lower-risk properties were interpreted as having a greater proportion of nonvegetative cover and/or open lawn. The ability to distinguish these fine scale differences among communities and individual properties illustrates the efficiency of a remote sensing/GIS-based approach for identifying peridomestic risk of Lyme disease over large geographic areas.

  5. Psychosocial and nonclinical factors predicting hospital utilization in patients of a chronic disease management program: a prospective observational study.

    PubMed

    Tran, Mark W; Weiland, Tracey J; Phillips, Georgina A

    2015-01-01

    Psychosocial factors such as marital status (odds ratio, 3.52; 95% confidence interval, 1.43-8.69; P = .006) and nonclinical factors such as outpatient nonattendances (odds ratio, 2.52; 95% confidence interval, 1.22-5.23; P = .013) and referrals made (odds ratio, 1.20; 95% confidence interval, 1.06-1.35; P = .003) predict hospital utilization for patients in a chronic disease management program. Along with optimizing patients' clinical condition by prescribed medical guidelines and supporting patient self-management, addressing psychosocial and nonclinical issues are important in attempting to avoid hospital utilization for people with chronic illnesses.

  6. The utility of cardiac stress testing for detection of cardiovascular disease in breast cancer survivors: a systematic review.

    PubMed

    Kirkham, Amy A; Virani, Sean A; Campbell, Kristin L

    2015-01-01

    Heart function tests performed with myocardial stress, or "cardiac stress tests", may be beneficial for detection of cardiovascular disease. Women who have been diagnosed with breast cancer are more likely to develop cardiovascular diseases than the general population, in part due to the direct toxic effects of cancer treatment on the cardiovascular system. The aim of this review was to determine the utility of cardiac stress tests for the detection of cardiovascular disease after cardiotoxic breast cancer treatment. Systematic review. Medline and Embase were searched for studies utilizing heart function tests in breast cancer survivors. Studies utilizing a cardiac stress test and a heart function test performed at rest were included to determine whether stress provided added benefit to identifying cardiac abnormalities that were undetected at rest within each study. Fourteen studies were identified. Overall, there was a benefit to utilizing stress tests over tests at rest in identifying evidence of cardiovascular disease in five studies, a possible benefit in five studies, and no benefit in four studies. The most common type of stress test was myocardial perfusion imaging, where reversible perfusion defects were detected under stress in individuals who had no defects at rest, in five of seven studies of long-term follow-up. Two studies demonstrated the benefit of stress echocardiography over resting echocardiography for detecting left ventricular dysfunction in anthracycline-treated breast cancer survivors. There was no benefit of stress cardiac magnetic resonance imaging in one study. Two studies showed a potential benefit of stress electrocardiography, whereas three others did not. The use of cardiac stress with myocardial perfusion imaging and echocardiography may provide added benefit to tests performed at rest for detection of cardiovascular disease in breast cancer survivors, and merits further research.

  7. The utility of cardiac stress testing for detection of cardiovascular disease in breast cancer survivors: a systematic review

    PubMed Central

    Kirkham, Amy A; Virani, Sean A; Campbell, Kristin L

    2015-01-01

    Background Heart function tests performed with myocardial stress, or “cardiac stress tests”, may be beneficial for detection of cardiovascular disease. Women who have been diagnosed with breast cancer are more likely to develop cardiovascular diseases than the general population, in part due to the direct toxic effects of cancer treatment on the cardiovascular system. The aim of this review was to determine the utility of cardiac stress tests for the detection of cardiovascular disease after cardiotoxic breast cancer treatment. Design Systematic review. Methods Medline and Embase were searched for studies utilizing heart function tests in breast cancer survivors. Studies utilizing a cardiac stress test and a heart function test performed at rest were included to determine whether stress provided added benefit to identifying cardiac abnormalities that were undetected at rest within each study. Results Fourteen studies were identified. Overall, there was a benefit to utilizing stress tests over tests at rest in identifying evidence of cardiovascular disease in five studies, a possible benefit in five studies, and no benefit in four studies. The most common type of stress test was myocardial perfusion imaging, where reversible perfusion defects were detected under stress in individuals who had no defects at rest, in five of seven studies of long-term follow-up. Two studies demonstrated the benefit of stress echocardiography over resting echocardiography for detecting left ventricular dysfunction in anthracycline-treated breast cancer survivors. There was no benefit of stress cardiac magnetic resonance imaging in one study. Two studies showed a potential benefit of stress electrocardiography, whereas three others did not. Conclusion The use of cardiac stress with myocardial perfusion imaging and echocardiography may provide added benefit to tests performed at rest for detection of cardiovascular disease in breast cancer survivors, and merits further research. PMID

  8. Clinical utility of quantitative multi-antibody Polycheck immunoassays in the diagnosis of coeliac disease.

    PubMed

    Konopka, Ewa; Grzywnowicz, Maciej; Oralewska, Beata; Cielecka-Kuszyk, Joanna; Trojanowska, Ilona; Cukrowska, Bożena

    2016-05-06

    To evaluate the clinical utility of multi-antibody strategies in the diagnosis of coeliac disease (CD), the new quantitative Polycheck immunoassays were analysed. Polycheck Celiac Panels (PCPs) are immunoenzyme screening assays for the quantitative measurement of coeliac-specific immunoglobulin class G (IgG) or class A (IgA) in serum. Lines of relevant antigens are coated together with five IgG or IgA standard lines used for the standard curve as positive control. PCP IgA consists of human recombinant human tissue transglutaminase (tTG) and deamidated gliadin peptides (DGP) as targets to detect IgA antibodies. PCP IgG consists of tTG, DGP and IF (intrinsic factor) antigens to detect antibodies in IgG class. PCPs were performed on 50 CD patients, including 6 cases with selective IgA deficiency, and 50 non-coeliac controls. CD diagnosis was performed according to the ESPGHAN recommendations: The presence of specific anti-tTG-IgA or anti-DGP-IgG (in the case of IgA deficiency) antibodies, typical histopathological changes in duodenal mucosa described in Marsh-Oberhüber classification as at least grade 2. The diagnosis of the majority of the control subjects was functional gastrointestinal disorders. The PCP results were compared with reference EliA Celikey. The usage of PCPs led to the correct identification of all CD patients. In our study, PCPs showed 100% agreement with the histopathological results. PCP IgA test showed a 98% concordance and correlated positively (R = 0.651, P = 0.0014) with EliA Celikey test. The highest specificity and positive predictive value (both 100%) were observed for the detection of Polycheck anti-tTG-IgA antibodies. The highest sensitivity and negative predictive value (both 100%) were achieved by Polycheck anti-DGP-IgG antibody detection. The best performance (98% sensitivity and negative predictive value, 100% specificity and positive predictive value, diagnostic accuracy - AU ROC 99%) was observed for the strategy of using both PCP

  9. Drug-induced Parkinsonism versus Idiopathic Parkinson Disease: Utility of Nigrosome 1 with 3-T Imaging.

    PubMed

    Sung, Young Hee; Noh, Young; Lee, Jongho; Kim, Eung Yeop

    2016-06-01

    Purpose To explore the utility of nigrosome 1 with 3-T magnetic resonance (MR) imaging to differentiate idiopathic Parkinson disease (IPD) from drug-induced parkinsonism (DIP). Materials and Methods The institutional review board approved this study, and participants gave informed consent. This study enrolled patients with DIP (n = 20) and IPD (n = 29) who underwent N-3-fluoropropyl-2-β-carbomethoxy-3-β-(4-iodophenyl)nortropane ((18)F-FP-CIT) positron emission tomography (PET) and healthy participants (n = 20). All participants underwent 0.5 × 0.5 × 1.0 mm(3) oblique axial three-dimensional multiecho-data image combination imaging to view the nigrosome 1 with 3-T imaging. Two reviewers independently assessed the nigrosome 1 without clinical information. DIP was diagnosed when no abnormality was seen at (18)F-FP-CIT PET. Diagnostic sensitivity, specificity, and accuracy of the nigrosome 1 imaging were evaluated between the IPD and DIP patients and between the IPD patients and healthy participants. Interrater agreement was assessed with Cohen κ. Results Both reviewers agreed in 63 of 69 participants (91.3%) for the presence of any abnormality on either side of the nigrosome 1 (κ = 0.825). Findings in all 29 IPD patients (100%) and three of 20 DIP patients (15%) were rated as abnormal and in 17 of 20 DIP patients (85%) they were interpreted as normal on the basis of imaging of the nitgrosome 1 (sensitivity, 100% (29 of 29); specificity, 85.0% (17 of 20); accuracy, 93.9% (46 of 49) between IPD and DIP patients). Findings in 3 of 20 healthy participants (15.0%) were interpreted as abnormal on the basis of imaging the nigrosome 1 while in the other 17 of 20 healthy participants (85.0%) they were rated as normal (sensitivity, 100% [29 of 29]; specificity, 85.0% [17 of 20]; accuracy, 93.9% [46 of 49] between IPD patients and healthy participants [κ = 0.831]). Conclusion The imaging of nigrosome 1 with 3-T imaging can differentiate DIP from IPD with high accuracy and

  10. Preliminary report on a cost-utility analysis of revascularization by percutaneous coronary intervention for ischemic heart disease.

    PubMed

    Takura, Tomoyuki; Tachibana, Kouichi; Isshiki, Takaaki; Sumitsuji, Satoru; Kuroda, Tadashi; Mizote, Isamu; Ide, Seiko; Nanto, Shinsuke

    2017-04-01

    Few socioeconomic studies have so far reported on revascularization for stable ischemic heart disease in Japan. This study aimed to validate the sensitivity of the health-related quality of life (HRQOL) scale for determining the pathology and medical technology to be used and to validate the application of a cost-utility analysis model. We studied 32 patients who had undergone percutaneous coronary intervention (PCI) (mean age 67.9 ± 7.3 years). For HRQOL, utility and quality of life (QOL) were examined using the EuroQol 5 Dimension (EQ-5D) and EuroQol Visual Analogue Scale (EQ-VAS), respectively. The changes in the utility index before and after PCI were compared between the PCI and coronary angiography (CAG) groups to determine the sensitivity of the EQ-5D that was used to calculate quality-adjusted life years (QALY). Additionally, to estimate the cost-utility of PCI 120 months after the procedure, we analyzed our study results and the results of previous reports using the Markov chain model. The utility index was found to improve in the PCI group (0.08 ± 0.15), whereas it decreased in the CAG group (-0.02 ± 0.11) (p = 0.049). The estimated result of the cost-utility analysis as the increase in utility above baseline level was the expected value, that is, 70,000 US$/QALY. Our findings suggest that QALY may be valid as a utility index in the clinical and economic evaluation of PCI in Japan.

  11. Utility and limitations of Addenbrooke's Cognitive Examination-Revised for detecting mild cognitive impairment in Parkinson's disease.

    PubMed

    Komadina, Natalie C; Terpening, Zoe; Huang, Yue; Halliday, Glenda M; Naismith, Sharon L; Lewis, Simon J G

    2011-01-01

    To evaluate the utility of the Addenbrooke's Cognitive Examination-Revised (ACE-R) as a screening tool for mild cognitive impairment in Parkinson's disease (PD-MCI). PD patients underwent comprehensive neuropsychological and neurological evaluations and ACE-R assessment. The ACE-R was superior to the Mini-Mental State Exam (MMSE) in detecting PD-MCI, with a cutoff score of ≤93 offering a sensitivity of 61% and a specificity of 64%. The utility of the ACE-R in detecting PD-MCI is largely influenced by the fluency sub-domain score, and has optimal discriminability when utilized in patients with lower levels of education (≤12 years of formal schooling). The ACE-R must be used cautiously as a screening tool for PD-MCI, with results being most influenced by its fluency sub-domain score and patient education levels. Copyright © 2011 S. Karger AG, Basel.

  12. A correlative study of simultaneously measured He(++) fluxes in the solar wind and in the magnetosphere utilizing Imp-1 and 1971-089A satellite data

    NASA Technical Reports Server (NTRS)

    Shelley, E. G.

    1975-01-01

    Simultaneously measured He(++) fluxes in the solar wind and in the magnetosphere were studied using data from the plasma spectrometer on the Imp I satellite and the energetic ion mass spectrometer on the low altitude polar orbiting satellite 1971-89A. A detailed comparison of the He(++) energy spectra measured simultaneously in the solar wind and in the low altitude dayside polar cusp on March 7, 1972 was made. The energy-per-unit-charge range of the energetic ion mass spectrometer on board the polar orbiting satellite was 700 eV to 12 keV. Within this range there was a clear maximum in the He(++) energy spectrum at approximately 1.5 keV/nucleon. There was not a clearly defined maximum in the H(+) spectrum, but the data were consistent with a peak between 0.7 and 1.0 keV/nucleon. Both spectra could be reasonably well fit with a convecting Maxwellian plus a high energy tail; however, the mean velocity for He(++) distribution was significantly greater than that for the H(+) distribution. The simultaneous solar wind measurements showed the mean velocities for both ion species to be approximately 600 km/sec. The discrepancies between the relative velocity distributions in the low altitude cusp and those in the solar wind are consistent with a potential difference of approximately 1.4 kV along their flow direction between the two points of observation.

  13. Utilization of satellite-derived estimates of meteorological and land surface characteristics in the Land Surface Model for vast agricultural region territory

    NASA Astrophysics Data System (ADS)

    Muzylev, Eugene; Startseva, Zoya; Uspensky, Alexander; Volkova, Elena

    2015-04-01

    The method has been elaborated to evaluate the water and heat regime characteristics of the territory on a regional scale for the vegetation season based on a physical-mathematical model of water and heat exchange between vegetation covered land surface and atmosphere (LSM, Land Surface Model) appropriate for using satellite information on land surface and meteorological conditions. The developed model is intended for calculating soil water content, evapotranspiration (evaporation from bare soil and transpiration by vegetation), vertical water and heat fluxes as well as land surface and vegetation cover temperatures and vertical distributions of temperature and moisture in the active soil layer. Parameters of the model are soil and vegetation characteristics and input variables are meteorological characteristics. Their values have been obtained from ground-based observations at agricultural meteorological stations and satellite-based measurements by scanning radiometers AVHRR/NOAA, MODIS/EOS Terra and Aqua and SEVIRI (geostationary satellites Meteosat-9, -10). The AVHRR data have been used to build the estimates of three types of land surface temperature (LST): land skin temperature Tsg, air temperature at a level of vegetation cover Ta and efficient radiation temperature Tseff, emissivity E, normalized vegetation index NDVI, vegetation cover fraction B, leaf area index LAI, and precipitation. The set of estimates derived from MODIS data has comprised values of LST Tls, E, NDVI and LAI. The SEVIRI-based retrievals have included Tls, Ta, Е at daylight and nighttime, LAI (daily) and precipitation. The case study has been carried out for agricultural Central Black Earth region of the European Russia of 227,300 sq.km containing 7 regions of the Russian Federation for years 2009-2013 vegetation seasons. Estimates of described characteristics have been built with the help of the developed original and improved pre-existing methods and technologies of thematic processing

  14. Study designs for identification of rare disease variants in complex diseases: the utility of family-based designs.

    PubMed

    Ionita-Laza, Iuliana; Ottman, Ruth

    2011-11-01

    The recent progress in sequencing technologies makes possible large-scale medical sequencing efforts to assess the importance of rare variants in complex diseases. The results of such efforts depend heavily on the use of efficient study designs and analytical methods. We introduce here a unified framework for association testing of rare variants in family-based designs or designs based on unselected affected individuals. This framework allows us to quantify the enrichment in rare disease variants in families containing multiple affected individuals and to investigate the optimal design of studies aiming to identify rare disease variants in complex traits. We show that for many complex diseases with small values for the overall sibling recurrence risk ratio, such as Alzheimer's disease and most cancers, sequencing affected individuals with a positive family history of the disease can be extremely advantageous for identifying rare disease variants. In contrast, for complex diseases with large values of the sibling recurrence risk ratio, sequencing unselected affected individuals may be preferable.

  15. A Global Information Utility.

    ERIC Educational Resources Information Center

    Block, Robert S.

    1984-01-01

    High-powered satellites, along with other existing technologies, make possible a world information utility that could distribute virtually limitless information to every point on earth. The utility could distribute information for business, government, education, and entertainment. How the utility would work is discussed. (RM)

  16. Identifying opportunities to improve aspirin utilization for the primary prevention of cardiovascular disease in a regional health care system.

    PubMed

    VanWormer, Jeffrey J; Miller, Aaron W; Rezkalla, H

    2014-10-01

    Aspirin is an important part of primary cardiovascular disease prevention, but little is known about aspirin use patterns in regional health care systems. This study used electronic health records from Marshfield Clinic to identify demographic, geographic, and clinical predictors of aspirin utilization in central Wisconsin adults without cardiovascular disease. A cross-sectional design was employed using 2010-2012 data from patients in the Marshfield Epidemiologic Study Area. Individuals who took aspirin-containing medication daily or every other day were considered regular aspirin users. There were a total of 6678 adults in the target region who were clinically indicated for aspirin therapy for primary cardiovascular disease prevention, per national guidelines. Aspirin was generally underutilized in this population, with 35% of all clinically indicated adults taking it regularly. Adjusted models found that individuals who were younger, female, not covered by health insurance, did not visit a medical provider regularly, smokers, were not obese, or did not have diabetes were least likely to take aspirin. In addition, there was some local variation in that aspirin use was less common in northeastern communities within the regional service area. Several aspirin use disparities were identified in central Wisconsin adults without cardiovascular disease, with particularly low utilization observed in those without diabetes and/or without regular physician contact. Methods of using electronic health records to conduct primary care surveillance as outlined here can be adopted by other large health care systems in the state to optimize future cardiovascular disease prevention initiatives.

  17. The role and utility of faecal markers in inflammatory bowel disease

    PubMed Central

    Lehmann, Frank S.; Burri, Emanuel

    2015-01-01

    Crohn’s disease and ulcerative colitis are characterized by periods of symptomatic relapse and remission. Diagnosis and assessment of inflammatory bowel disease has so far been based on clinical evaluation, serum parameters, radiology and endoscopy. Faecal markers such as calprotectin or lactoferrin have emerged as new diagnostic tools to detect and monitor intestinal inflammation. This review focuses on their potential clinical applications and limitations in the management of inflammatory bowel disease. PMID:25553077

  18. Utility of infectious disease coding sheets for surveillance in a state medical examiner's office.

    PubMed

    Lathrop, Sarah L; Paul, Ian D; Schwartz, Michael H; Nolte, Kurt B

    2008-07-01

    Medical examiners are often first to recognize unusual occurrences of fatal infectious diseases. Recognition of these deaths allows public health officials to institute appropriate public health measures. Therefore, we developed a simple method of identifying and tracking infectious disease deaths in a statewide medical examiner's office. One-page infectious disease forms were completed for 1566/1949 autopsies (80%) performed at the New Mexico Office of the Medical Investigator in 2004. In 241 cases one infectious disease was identified at autopsy and 58 cases had two infectious diseases. Fourteen of the infectious-diseases caused deaths involved diseases that are notifiable conditions in New Mexico. Pneumonia was the most commonly reported infectious process (47 deaths) followed by sepsis (25 deaths). Tracking infectious disease deaths highlighted the importance of recognizing these deaths, although hand-written entries were unstandardized. Preferably, a tracking system would be built into electronic databases at medical examiner and coroner's offices, expediting the identification of these diseases and contact of public health agencies.

  19. Study of Drug Utilization Pattern for Skin Diseases in Dermatology OPD of an Indian Tertiary Care Hospital - A Prescription Survey

    PubMed Central

    Pathak, Anuj Kumar; Kumar, Subodh; Kumar, Manish; Dikshit, Harihar

    2016-01-01

    Introduction Skin diseases are the major contributors of disease burden in society. It affects individuals of all ages, neonates to elderly. Owing to its chronic nature, it causes serious impact on quality of life and financial status of the sufferer and his family. The problem gets compounded with the inappropriate and irrational use of medicines. Periodic prescription audit in form of drug utilization study is a way to improve the quality of prescription and curb the menace of irrational prescribing which has become a global phenomenon. Aim This study aims to determine the drug utilization pattern and assess the economic burden of the patient with skin disease. Materials and Methods It was a prospective, cross-sectional study conducted over a period of three months from January to March 2015 in newly diagnosed cases attending outpatient department of Skin and VD, IGIMS, Patna. The prescriptions were analysed with the help of descriptive statistics and results were expressed in percentage. Results Total 752 prescriptions were analysed during the study. Male patients were lesser as compared to female as male to female ratio was 0.88. Over 50% of patients were in adolescent age group i.e. 21-40 years. Acne (17.95%) was most common disease in the study population followed by eczema and Dermatophytosis. Among the drugs, antihistaminics (24.13%) were prescribed most frequently followed by antifungals and antibiotics. Topical agents constituted almost 60% of the total prescription and average number of drugs per prescription was 5.13, irrespective of the dosage forms prescribed. Conclusion This drug utilization study provides an insight to the prescriber regarding various issues related to polypharmacy, cost analysis and prevalent disease pattern in the region. This study also suggests periodic evaluation of prescription pattern to monitor and improve quality of prescription in other departments of the hospital. PMID:27042479

  20. Variables Associated With Inpatient and Outpatient Resource Utilization Among Medicare Beneficiaries With Nonalcoholic Fatty Liver Disease With or Without Cirrhosis

    PubMed Central

    Sayiner, Mehmet; Otgonsuren, Munkhzul; Cable, Rebecca; Younossi, Issah; Afendy, Mariam; Golabi, Pegah; Henry, Linda

    2017-01-01

    Background: Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease worldwide with tremendous clinical burden. The economic burden of NAFLD is not well studied. Goal: To assess the economic burden of NAFLD. Study: Medicare beneficiaries (January 1, 2010 to December 31, 2010) with NAFLD diagnosis by International Classification of Diseases, Ninth Revision codes in the absence of other liver diseases were selected. Inpatient and outpatient resource utilization parameters were total charges and total provider payments. NAFLD patients with compensated cirrhosis (CC) were compared with decompensated cirrhosis (DC). Results: A total of 976 inpatients and 4742 outpatients with NAFLD were included—87% were white, 36% male, 30% had cardiovascular disease (CVD) or metabolic syndrome conditions, and 12% had cirrhosis. For inpatients, median total hospital charge was $36,289. NAFLD patients with cirrhosis had higher charges and payments than noncirrhotic NAFLD patients ($61,151 vs. $33,863 and $18,804 vs. $10,146, P<0.001). Compared with CC, NAFLD patients with DC had higher charges and payments (P<0.02). For outpatients, median total charge was $9,011. NAFLD patients with cirrhosis had higher charges and payments than noncirrhotic NAFLD patients ($12,049 vs. $8,830 and $2,586 vs. $1,734, P<0.001). Compared with CC, DC patients had higher total charges ($15,187 vs. $10,379, P=0.04). In multivariate analysis, variables associated with increased inpatient resource utilization were inpatient mortality, DC, and CVD; for outpatients, having CVD, obesity, and hypertension (all P<0.001). Conclusions: NAFLD is associated with significant economic burden to Medicare. Presence of cirrhosis and CVD are associated with increased resource utilization. PMID:27332747

  1. Urologic diseases in North America Project: trends in resource utilization for urinary tract infections in children.

    PubMed

    Freedman, Andrew L

    2005-03-01

    We evaluated the health utilization and economic burden on society of urinary tract infections (UTIs) in children using a variety of public and commercial health care databases. Numerous available databases were evaluated for health care utilization, including inpatient hospitalization, and outpatient physician and emergency department visits, by children with a coded diagnosis of urinary tract infection. Utilization was analyzed by age, gender, race, insurance type and geographic location, and trends were assessed during the last decade. UTIs resulted in more than 1.1 million physician visits annually, accounting for 0.7% of doctor visits and occurring in 2.4% to 2.8% of children. Overall, inpatient hospitalization decreased slightly, although pyelonephritis still accounted for more than 13,000 admissions. Infants were more likely to receive inpatient care for UTIs than children or adolescents, although hospital costs were higher in adolescents. Inpatient hospital costs are estimated to be greater than 180 million dollars per year. Pediatric UTIs constitute a significant health burden on society. Available data do not allow a full accounting of costs due to a lack of information regarding outpatient expenses, as well as the cost of ancillary evaluation and treatment. However, the magnitude of the burden suggests the importance of further research and data collection of health care utilization in the pediatric population.

  2. Utilizing Dental Electronic Health Records Data to Predict Risk for Periodontal Disease.

    PubMed

    Thyvalikakath, Thankam P; Padman, Rema; Vyawahare, Karnali; Darade, Pratiksha; Paranjape, Rhucha

    2015-01-01

    Periodontal disease is a major cause for tooth loss and adversely affects individuals' oral health and quality of life. Research shows its potential association with systemic diseases like diabetes and cardiovascular disease, and social habits such as smoking. This study explores mining potential risk factors from dental electronic health records to predict and display patients' contextualized risk for periodontal disease. We retrieved relevant risk factors from structured and unstructured data on 2,370 patients who underwent comprehensive oral examinations at the Indiana University School of Dentistry, Indianapolis, IN, USA. Predicting overall risk and displaying relationships between risk factors and their influence on the patient's oral and general health can be a powerful educational and disease management tool for patients and clinicians at the point of care.

  3. Utility of high-resolution MR imaging in demonstrating transmural pathologic changes in Crohn disease.

    PubMed

    Sinha, Rakesh; Rajiah, Prabhakar; Murphy, Paul; Hawker, Peter; Sanders, Scott

    2009-10-01

    Magnetic resonance (MR) imaging has emerged as an imaging modality that can be used to help diagnose and evaluate Crohn disease of the small and large bowel. MR imaging has high diagnostic accuracy in the detection of Crohn disease, and high-resolution thin-section MR images can demonstrate transmural pathologic changes of Crohn disease from the level of the mucosa to that of the mesentery. High-resolution MR image data also may be used to construct high-quality multiplanar and endoluminal views that may provide additional diagnostic information. Knowledge of the MR imaging findings of Crohn disease and how they correlate with the pathologic features of the disease is important to facilitate accurate diagnosis and detect complications.

  4. Prescribe by risk: the utility of a biomarker-based risk calculation in disease management to prevent heart disease.

    PubMed

    Root, Martin; Smith, Timothy

    2005-04-01

    Preventive treatment for those most at risk of heart disease rather than those with the highest blood pressure or cholesterol values may be a more efficacious strategy for disease management. This depends on accurate biomarker-based risk assessment tools. An evidence-based model of heart disease risk was developed using the Framingham model with an additional five risk factors, including three of the newer blood biomarkers. This was applied to the adult population of the 3rd National Health and Nutrition Examination Survey cohort. Additionally, the selection criteria for therapeutic intervention from the Adult Treatment Panel III guidelines (for hyperlipidemia) and the 7th Report of the Joint National Committee (for hypertension) were applied to the same subjects. Of this cohort 54% qualified for at least one of these medications while 18% qualified for both. Using this 18% cutoff, the 18% of the subjects with the highest calculated heart disease risk were also identified using the developed risk model. We applied established therapeutic reductions in heart disease probability to those identified by guidelines and to those identified by risk. Applying both drugs to the high-risk group (one third the size of the guidelines group) achieved the same reduction in population risk (about one fourth) as applying the drugs to the guideline groups and required only half as many prescriptions. Intermediate results were found when an intervention group was identified by a combination of both high risk and high levels of risk factors. In this simulation, identifying patients by heart disease risk level resulted in substantially fewer people being treated with fewer drugs and achieving a similar reduction in disease risk.

  5. Impact of disease management on health care utilization: evidence from the "Florida: A Healthy State (FAHS)" Medicaid Program.

    PubMed

    Afifi, Abdelmonem A; Morisky, Donald E; Kominski, Gerald F; Kotlerman, Jenny B

    2007-06-01

    To examine the impact of disease management on utilization of selected health care services. Prospective observational population-based study comparing Florida Medicaid patients who elected to participate in disease management (DM, N=15,275) with a usual-care (UC, N=32,034) group who elected not to participate in the program. Patients had at least one of four chronic diseases (diabetes, asthma, congestive heart failure, and hypertension) and all received standard health care. DM participants received supplementary telephone health counseling by a managed care specialist. The data for this paper were collected between October 2001 and October 2004. Annual rates of inpatient hospital stays, inpatient days, emergency room (ER) visits, and outpatient (OP) visits, during and post intervention, were used as outcomes. Age, race, gender, comorbidities, severity indicators, geographic location and pre-intervention utilization were used as covariates. Compared to UC patients, DM patients had lower adjusted post intervention annualized rates of hospitalizations ranging from 0.07 to 0.38 stays, lower rates of hospital days ranging from 0.40 to 2.54 days, and lower rates of ER visits ranging from 0.10 to 0.91 visits per DM enrollee in all four chronic conditions. Most results were statistically significant at the 5% level, except for hypertension patients, where they were suggestive, though not significant. Disease management is effective in reducing potentially avoidable inpatient hospital stays and ER visits among patients with chronic illness.

  6. Utilization of stem cells to treat congenital heart disease: hype and hope.

    PubMed

    Peral, Susana Cantero; Burkhart, Harold M; Nelson, Timothy J

    2014-10-01

    Surgical advances over the past few decades have transformed the clinical management of congenital heart disease, such as hypoplastic left heart syndrome. Congenital heart disease affects more than 1% of liveborn infants and accounts for more than 2.5 million affected children per year worldwide. The cost and availability of complex medical management for these children becomes bluntly realized when heart failure progresses and only palliative options remain. Cell-based cardiac regeneration has been the focus of intensive efforts in adult heart disease for more than a decade and now has promise for pediatrics. Innate cardiac regeneration in the pediatric setting is measurable and potentially modifiable in the early stages of development. Repurposing cell-based manufactured products to promote cardiac regeneration in congenital heart disease has demonstrated significant improvement in cases of dilated cardiomyopathy and structural heart disease in infants. A focus on preemptive cardiac regeneration in the pediatric setting may offer new insights into the timing of surgery, location of cell-based delivery, and type of cell-based regeneration that could further inform acquired cardiac disease applications. The concept of cell-based pediatric cardiac regenerative surgery could transform the management of congenital heart disease when cost-effective strategies produce a valuable adjunctive solution to improve outcomes of cardiac surgery.

  7. Utility of combinations of biomarkers, cognitive markers, and risk factors to predict conversion from mild cognitive impairment to Alzheimer disease in patients in the Alzheimer's disease neuroimaging initiative.

    PubMed

    Gomar, Jesus J; Bobes-Bascaran, Maria T; Conejero-Goldberg, Concepcion; Davies, Peter; Goldberg, Terry E

    2011-09-01

    Biomarkers have become increasingly important in understanding neurodegenerative processes associated with Alzheimer disease. Markers include regional brain volumes, cerebrospinal fluid measures of pathological Aβ1-42 and total tau, cognitive measures, and individual risk factors. To determine the discriminative utility of different classes of biomarkers and cognitive markers by examining their ability to predict a change in diagnostic status from mild cognitive impairment to Alzheimer disease. Longitudinal study. We analyzed the Alzheimer's Disease Neuroimaging Initiative database to study patients with mild cognitive impairment who converted to Alzheimer disease (n = 116) and those who did not convert (n = 204) within a 2-year period. We determined the predictive utility of 25 variables from all classes of markers, biomarkers, and risk factors in a series of logistic regression models and effect size analyses. The Alzheimer's Disease Neuroimaging Initiative public database. Primary outcome measures were odds ratios, pseudo- R(2)s, and effect sizes. In comprehensive stepwise logistic regression models that thus included variables from all classes of markers, the following baseline variables predicted conversion within a 2-year period: 2 measures of delayed verbal memory and middle temporal lobe cortical thickness. In an effect size analysis that examined rates of decline, change scores for biomarkers were modest for 2 years, but a change in an everyday functional activities measure (Functional Assessment Questionnaire) was considerably larger. Decline in scores on the Functional Assessment Questionnaire and Trail Making Test, part B, accounted for approximately 50% of the predictive variance in conversion from mild cognitive impairment to Alzheimer disease. Cognitive markers at baseline were more robust predictors of conversion than most biomarkers. Longitudinal analyses suggested that conversion appeared to be driven less by changes in the neurobiologic

  8. Diagnostic utility of coeliac disease: a descriptive study in a tertiary care hospital, oman.

    PubMed

    Al Saidi, Safana Salim; Al Harthi, Salim Omar; Mula-Abed, Waad-Allah Sharef

    2013-07-01

    The prevalence of coeliac disease in Oman is unknown. We aim to estimate the prevalence of coeliac disease in at-risk subjects, describe the clinical characteristics and laboratory findings associated with coeliac disease and the validity of serological testing for coeliac disease at the Royal Hospital, Oman over a period of three years. This is a retrospective case finding study. The medical and laboratory records were reviewed for patients for whom serum antiendomysium IgA antibodies were requested at the Royal Hospital during a 3-year period (1(st) Jan 2006-31(st) Dec 2008). The data were extracted in order to assess the following: a) Prevalence rate of coeliac disease among at-risk subjects; b) Clinical characteristics in patients with coeliac disease and clinical manifestations for which the requesting clinicians considered coeliac disease as a possible diagnosis, including their specialties; c) Laboratory tests results in patients with coeliac disease; and d) Validity of antiendomysium antibodies testing in comparison with histopathology of jejunal biopsies for diagnosing coeliac disease. The study included 431 patients (250 females, 181 males) who were suspected of having (or screened for) coeliac disease. The median of age was 15 years (range: 9 months-74 years) with mean ± SD 18.95 ± 14.1 years. Of these, 15 (3.5%) patients (10 females, 5 males) with a median age of 19 years and mean 21.4 ± 13.0 years (range: 2.5-38 years), had positive antiendomysium antibodies results with median (range) of 160 (40-320) IU/L and mean± SD 204.5 ± 160 IU/L. Of these 15 patients, 13 had positive jejunal histopathological changes indicative of coeliac disease; the remaining 2 patients had no biopsy examination. Of the 44 patients with negative antiendomysium antibodies <10 IU/L who had jejunal biopsy, 41 were negative and 3 had histopathological changes suggestive of mild coeliac disease. All the 3 patients had serum total IgA levels within the reference range. The

  9. Difficult diagnosis of celiac disease: diagnostic accuracy and utility of chromo-zoom endoscopy.

    PubMed

    Iovino, Paola; Pascariello, Annalisa; Russo, Ilaria; Galloro, Giuseppe; Pellegrini, Lucienne; Ciacci, Carolina

    2013-02-01

    Chromo-zoom endoscopy has been demonstrated to be valuable in assessing the degree of intestinal villous atrophy in patients with suspected celiac disease. To evaluate the diagnostic accuracy of chromo-zoom endoscopy in patients with difficult diagnosis because of nonconcordant test results and/or the confounding of a gluten-free diet initiated before an appropriate diagnosis of celiac disease and to compare the findings to a recent reference standard, the in vitro gliadin challenge test. Prospective, case-control study. Tertiary-care referral hospital. Patients without celiac disease (negative control group, n = 9), patients with celiac disease (positive control group, n = 41), and patients with difficult diagnosis (n = 27). Chromo-endoscopy with indigo carmine and endoscopic zoom-magnification were performed. Duodenal fragments were collected for the in vitro gliadin challenge test. The area under the receiver operating characteristic curve (ROC) was used for statistical analyses on accuracy. Diagnostic accuracy of chromo-zoom endoscopy for detection of mucosal abnormalities in patients with difficult diagnosis. Chromo-zoom endoscopy had a high accuracy for celiac disease diagnosis in analyses on negative controls and positive controls (area under roc = 0.99). In the difficult diagnosis group, the accuracy of chromo-zoom endoscopy was lower (area under roc = 0.83), but it increased after exclusion of patients with celiac disease on gluten-free diet (area under roc = 0.88). There was a 4% failure rate in the ability to cultivate biopsies. Also, the study was done at an academic medical center. Chromo-zoom endoscopy has high accuracy for cases of difficult diagnosis of celiac disease but only in untreated patients with celiac disease. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  10. In vitro gliadin challenge: diagnostic accuracy and utility for the difficult diagnosis of celiac disease.

    PubMed

    Tortora, Raffaella; Russo, Ilaria; De Palma, Giovanni D; Luciani, Alessandro; Rispo, Antonio; Zingone, Fabiana; Iovino, Paola; Capone, Pietro; Ciacci, Carolina

    2012-01-01

    Diagnosis of celiac disease is difficult when treatment with gluten-free diet (GFD) is started before diagnosis and/or when the results of tests are inconsistent. The objective of this study was to evaluate the in vitro gliadin challenge. The study cohort included patients without celiac disease (negative controls, n=57), patients with celiac disease (positive controls, n=166 untreated and n=55 on GFD), and patients with difficult diagnosis (n=59). All patients underwent endoscopy for collection of duodenal samples, which served for the diagnosis of celiac disease and for the in vitro evaluation of the gliadin-induced mucosal expression of seven inflammatory markers: PY99, ICAM-1 (intercellular cell adhesion molecule), HLA-DR, CD3, CD25, CD69, and transglutaminase 2 IgA. Diagnostic work-up for celiac disease included the search of specific serum antibodies. Patients of the difficult diagnosis group were asked to stop GFD for repeated search of these antibodies under untreated conditions. The area under the receptor-operated curve (ROC) was used for statistical analyses on accuracy. HLA-DR had the highest accuracy for celiac disease diagnosis in analyses on negative controls and positive controls also excluding patients on GFD (area under ROC=0.99). Accuracy of test did not increase combining data of HLA-DR with data of other markers. Findings were similar in the 39 patients of the difficult diagnosis group undergoing the search celiac disease-specific antibodies under untreated conditions. The in vitro response of mucosal HLA-DR to gliadin is an accurate tool for the diagnosis of celiac disease also in patients with difficult diagnosis.

  11. Migraine and tension type headache in adolescents at grammar school in Germany - burden of disease and health care utilization.

    PubMed

    Albers, Lucia; Straube, Andreas; Landgraf, Mirjam N; Filippopulos, Filipp; Heinen, Florian; von Kries, Rüdiger

    2015-01-01

    Tension-type headache and migraine are among the most prevalent chronic disorders in children/adolescents. Data on health care utilization for headache in this age group, however, are sparse. In 1399 grammar school students (aged 12-19 years) with headache in the last six months in Germany a) the burden of disease for headache (mean intensity, mean frequency in the last three months and PedMIDAS means), b) medical care utilization defined by proportion of students consulting a physician in the last 12 months and/or taking analgetic drugs in the last three months by headache types (migraine and tension-type headache) and by burden of disease were assessed. Primary headache substantially impaired daily living activities in adolescents which was mainly related to migraine. Medical care utilization and drug use, however, was low (consulting a physician: 12.0 %, 95 %-CI = [10.3-13.8]; taking analgetic drugs: 29.9 %, 95 %-CI = [27.5-32.4]) - even among students with severe headache (physician consultation: <35 %; taking analgetic drugs: <63 %). Two thirds of students with any headache and 40 % of those with migraine had neither seen a physician nor used analgetic drugs because of their headache in the preceding 12 months. Adolescents with headache might too rarely seek professional help for treatment of headache. Health promotion in adolescents should increase awareness for evidence-based treatment options for headache.

  12. Disparities in utilization of coronary artery disease treatment by gender, race, and ethnicity: opportunities for prevention.

    PubMed

    Bhalotra, Sarita; Ruwe, Mathilda B M; Strickler, Gail K; Ryan, Andrew M; Hurley, Clare L

    2007-07-01

    Racial, ethnic, (R/E) and gender disparities in access to health services in the United States and their relationship to adverse health outcomes are well established. Despite an increase in evidence-based cardiovascular treatment, gender, racial, and ethnic disparities in coronary artery disease (CAD) treatment persist. There is neither currently a comprehensive framework for understanding why disparities occur in cardiovascular disease care, nor viable solutions for intervention. This article synthesizes the literature on disparities in coronary artery disease with a conceptual model for understanding chronic disease disparities. This article follows the natural history of disease to observe where differences arise, beginning with health risk management, screening, diagnosis, treatment, and rehabilitation. Racial, ethnic, and gender differences were found at every step of this continuum, including a higher burden of risk factors and a less likelihood of receiving needed lifesaving cardiac procedures. Unfortunately, there is a dearth of intervention strategies to reduce racial, ethnic, and gender disparities in coronary artery disease. Comprehensive solutions will require addressing the barriers at the system, the provider, and the patient level. An early intervention approach that addresses multiple risk factors should be a high priority.

  13. Utility of R0 as a predictor of disease invasion in structured populations

    USGS Publications Warehouse

    Cross, P.C.; Johnson, P.L.F.; Lloyd-Smith, J. O.; Getz, W.M.

    2007-01-01

    Early theoretical work on disease invasion typically assumed large and well-mixed host populations. Many human and wildlife systems, however, have small groups with limited movement among groups. In these situations, the basic reproductive number, R0, is likely to be a poor predictor of a disease pandemic because it typically does not account for group structure and movement of individuals among groups. We extend recent work by combining the movement of hosts, transmission within groups, recovery from infection and the recruitment of new susceptibles into a stochastic model of disease in a host metapopulation. We focus on how recruitment of susceptibles affects disease invasion and how population structure can affect the frequency of superspreading events (SSEs). We show that the frequency of SSEs may decrease with the reduced movement and the group sizes due to the limited number of susceptible individuals available. Classification tree analysis of the model results illustrates the hierarchical nature of disease invasion in host metapopulations. First, the pathogen must effectively transmit within a group (R0 > 1), and then the pathogen must persist within a group long enough to allow for movement among the groups. Therefore, the factors affecting disease persistence - such as infectious period, group size and recruitment of new susceptibles - are as important as the local transmission rates in predicting the spread of pathogens across a metapopulation. ?? 2006 The Royal Society.

  14. Clinical utility of viscoelastic tests of coagulation in patients with liver disease.

    PubMed

    Mallett, Susan V; Chowdary, Pratima; Burroughs, Andrew K

    2013-08-01

    The prothrombin time (PT) and international normalised ratio (INR) are used in scoring systems (Child-Pugh, MELD, UKELD) in chronic liver disease and as a prognostic tool and for dynamic monitoring of hepatic function in acute liver disease. These tests are known to be poor predictors of bleeding risk in liver disease; however, they continue to influence clinical management decisions. Recent work on coagulation in liver disease, in particular thrombin generation studies, has led to a paradigm shift in our understanding and it is now recognised that haemostasis is relatively well preserved. Whole blood global viscoelastic tests (TEG(®) /ROTEM(®) ) produce a composite dynamic picture of the entire coagulation process and have the potential to provide more clinically relevant information in patients with liver disease. We performed a systematic review of all relevant studies that have used viscoelastic tests (VET) of coagulation in patients with liver disease. Although many studies are observational and small in size, it is clear that VET provide additional information that is in keeping with the new concepts of how coagulation is altered in these patients. This review provides the basis for large scale, prospective outcome studies to establish the clinical value of these tests. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. D3-2: Forecasting Disease Burden and Health Utilization in Uninsured Populations in California Health Insurance Exchange Pricing Regions

    PubMed Central

    Dinh, Tuan

    2014-01-01

    Background/Aims Starting in January 2014, millions of currently uninsured Californians will be able to purchase health insurance on the California Health Insurance Exchange (HIE). For planning purposes, it is important to estimate disease burden and demands for services in uninsured populations. The Archimedes Model is a trial-validated, clinically detailed simulation model of human physiology, disease progression, and healthcare delivery. The Archimedes Model synthesizes evidence from hundreds of data sources to create virtual patients that are representative of the US population, in terms of demographic distribution, disease progression, clinical outcomes, patient and provider behaviors; office visits and hospital admissions; tests and treatments; care delivery protocols; compliance; and costs. Kaiser Permanente and Archimedes collaborated to develop a capability based on the Archimedes Model to forecast disease burden and healthcare utilization in uninsured populations for each of the 18 California Health Insurance Exchange pricing regions. Methods We used data from 20 diverse California and US surveys and databases as inputs into the Archimedes Model to create realistic individuals that closely match the uninsured populations in each pricing region, with respect to demographics, socioeconomic status, and medical conditions. Within the Archimedes Model, the relationships between biomarkers, medication adherence and usage, disease progression, clinical outcomes, care processes and healthcare utilizations are well-established and carefully validated against many independent datasets. We use the Archimedes Model to combine datasets with overlapping information and to fill in the missing information for uninsured Californians, then forecast the clinical outcomes and health utilizations in the next 10 years for this population as well as the benefits and costs of different prevention and disease management strategies. Results We created 19 datasets that are

  16. Satellite Operations in Alaska

    NASA Astrophysics Data System (ADS)

    Kreller, M. A.

    2016-12-01

    Numerous observational challenges exist across Alaska impacting National Weather Service (NWS) forecast operations and providing decision support services (DSS) to critical core partners and customers. These observational challenges range from limited utility of GOES imagery at higher latitudes, scarcity of observing platforms, to limited radar coverage. Although we are fortunate to receive these valuable and limited data sets, there still remain extensive spatial and temporal data gaps across Alaska. Many forecast challenges in Alaska are similar to those in the CONUS with the detection and monitoring of wildfire conditions, severe thunderstorms, river flooding, and coastal flooding, etc. There are additional unique DSS provided in Alaska including sea ice forecasting, ivu (ice shoves onshore), coastal erosion due to permafrost melt, and extreme hazardous winter conditions (temperatures as low as -80F). In addition to the observational and forecast challenges, the sheer size of the area of responsibility in Alaska is a challenge. NWS operations have always heavily relied on satellite imagery to quickly assess the current weather situation and provide forecast guidance. NWS operations have established several partnerships with the satellite community to help with these challenges. In particular the GOES-R and Joint Polar Satellite System (JPSS) OCONUS Satellite Proving Ground (PG) Programs have not only improved Alaska's observational challenges, but continue to identify new capabilities with the next generation geostationary and polar-orbiting satellite products.. For example, River ice and flood detection products derived from the Suomi-NPP VIIRS satellite imagery with the support of the JPSS Proving Ground and Risk Reduction Program. This presentation will provide examples of how new satellite capabilities are being used in NWS Alaska forecast operations to support DSS, with emphasis on JPSS satellite products. Future satellite utilization or operational needs

  17. Mobile satellite service communications tests using a NASA satellite

    NASA Technical Reports Server (NTRS)

    Chambers, Katherine H.; Koschmeder, Louis A.; Hollansworth, James E.; ONeill, Jack; Jones, Robert E.; Gibbons, Richard C.

    1995-01-01

    Emerging applications of commercial mobile satellite communications include satellite delivery of compact disc (CD) quality radio to car drivers who can select their favorite programming as they drive any distance; transmission of current air traffic data to aircraft; and handheld communication of data and images from any remote corner of the world. Experiments with the enabling technologies and tests and demonstrations of these concepts are being conducted before the first satellite is launched by utilizing an existing NASA spacecraft.

  18. Mobile satellite service communications tests using a NASA satellite

    NASA Technical Reports Server (NTRS)

    Chambers, Katherine H.; Koschmeder, Louis A.; Hollansworth, James E.; ONeill, Jack; Jones, Robert E.; Gibbons, Richard C.

    1995-01-01

    Emerging applications of commercial mobile satellite communications include satellite delivery of compact disc (CD) quality radio to car drivers who can select their favorite programming as they drive any distance; transmission of current air traffic data to aircraft; and handheld communication of data and images from any remote corner of the world. Experiments with the enabling technologies and tests and demonstrations of these concepts are being conducted before the first satellite is launched by utilizing an existing NASA spacecraft.

  19. Utilization of satellite remote sensing data on land surface characteristics in water and heat balance component modeling for vegetation covered territories

    NASA Astrophysics Data System (ADS)

    Muzylev, Eugene; Uspensky, Alexander; Startseva, Zoya; Volkova, Elena; Kukharsky, Alexander; Uspensky, Sergey

    2010-05-01

    The model of vertical water and heat transfer in the "soil-vegetation-atmosphere" system (SVAT) for vegetation covered territory has been developed, allowing assimilating satellite remote sensing data on land surface condition as well as accounting for heterogeneities of vegetation and meteorological characteristics. The model provides the calculation of water and heat balance components (such as evapotranspiration Ev, soil water content W, sensible and latent heat fluxes and others ) as well as vertical soil moisture and temperature distributions, temperatures of soil surface and foliage, land surface brightness temperature for any time interval within vegetation season. To describe the landscape diversity soil constants and leaf area index LAI, vegetation cover fraction B, and other vegetation characteristics are used. All these values are considered to be the model parameters. Territory of Kursk region with square about 15 thousands km2 situated in the Black Earth zone of Central Russia was chosen for investigation. Satellite-derived estimates of land surface characteristics have been constructed under cloud-free condition basing AVHRR/NOAA, MODIS/EOS Terra and EOS Aqua, SEVIRI/Meteosat-8, -9 data. The developed technologies of AVHRR data thematic processing have been refined providing the retrieval of surface skin brightness temperature Tsg, air foliage temperature Ta, efficient surface temperature Ts.eff and emissivity E, as well as derivation of vegetation index NDVI, B, and LAI. The linear regression estimators for Tsg, Ta and LAI have been built using representative training samples for 2003-2009 vegetation seasons. The updated software package has been applied for AVHRR data thematic processing to generate named remote sensing products for various dates of the above vegetation seasons. The error statistics of Ta, Ts.eff and Тsg derivation has been investigated for various samples using comparison with in-situ measurements that has given RMS errors in the

  20. The clinical utility of QSM: disease diagnosis, medical management, and surgical planning.

    PubMed

    Eskreis-Winkler, Sarah; Zhang, Yan; Zhang, Jingwei; Liu, Zhe; Dimov, Alexey; Gupta, Ajay; Wang, Yi

    2017-04-01

    Quantitative susceptibility mapping (QSM) is an MR technique that depicts and quantifies magnetic susceptibility sources. Mapping iron, the dominant susceptibility source in the brain, has many important clinical applications. Herein, we review QSM applications in the diagnosis, medical management, and surgical treatment of disease. To assist in early disease diagnosis, QSM can identify elevated iron levels in the motor cortex of amyotrophic lateral sclerosis patients, in the substantia nigra of Parkinson's disease (PD) patients, in the globus pallidus, putamen, and caudate of Huntington's disease patients, and in the basal ganglia of Wilson's disease patients. Additionally, QSM can distinguish between hemorrhage and calcification, which could prove useful in tumor subclassification, and can measure microbleeds in traumatic brain injury patients. In guiding medical management, QSM can be used to monitor iron chelation therapy in PD patients, to monitor smoldering inflammation of multiple sclerosis (MS) lesions after the blood-brain barrier (BBB) seals, to monitor active inflammation of MS lesions before the BBB seals without using gadolinium, and to monitor hematoma volume in intracerebral hemorrhage. QSM can also guide neurosurgical treatment. Neurosurgeons require accurate depiction of the subthalamic nucleus, a tiny deep gray matter nucleus, prior to inserting deep brain stimulation electrodes into the brains of PD patients. QSM is arguably the best imaging tool for depiction of the subthalamic nucleus. Finally, we discuss future directions, including bone QSM, cardiac QSM, and using QSM to map cerebral metabolic rate of oxygen. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  1. Utility of serological markers in inflammatory bowel diseases: gadget or magic?

    PubMed

    Papp, Maria; Norman, Gary L; Altorjay, Istvan; Lakatos, Peter Laszlo

    2007-04-14

    The panel of serologic markers for inflammatory bowel diseases (IBD) is rapidly expanding. Although anti-Saccharomyces cerevisiae antibodies (ASCA) and atypical perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) remain the most widely investigated, an increasing amount of experimental data is available on newly discovered antibodies directed against various microbial antigens. The role of the assessment of various antibodies in the current IBD diagnostic algorithm is often questionable due to their limited sensitivity. In contrast, the association of serologic markers with disease behavior and phenotype is becoming increasingly well-established. An increasing number of observations confirms that patients with Crohn's disease expressing multiple serologic markers at high titers are more likely to have complicated small bowel disease (e.g. stricture and/or perforation) and are at higher risk for surgery than those without, or with low titers of antibodies. Creating homogenous disease sub-groups based on serologic response may help develop more standardized therapeutic approaches and may help in a better understanding of the pathomechanism of IBD. Further prospective clinical studies are needed to establish the clinical role of serologic tests in IBD.

  2. Utility of quantitative ultrasound for tracking the progression of polycystic kidney disease

    NASA Astrophysics Data System (ADS)

    Hall, Timothy J.; Khant, Htet A.; Insana, Michael F.; Wood, John G.; Zhu, Yanning; Preston, David; Cowley, Benjamin D.

    2000-04-01

    We are combining techniques of quantitative ultrasonic imaging to study polycystic kidney disease (PKD) as the disease progresses to renal failure. Our goal is to use ultrasound noninvasively to detect morphological changes early in the disease process when interventions are most likely to be successful and prior to a significant loss in renal function. We are examining the kidneys of normal rats and those with PKD at various ages with several techniques to obtain comprehensive knowledge of the disease progression. The Han:SPRD rat inherits PKD as an autosomal dominant trait (ADPKD) that closely mimics ADPKD in humans. Changes in renal function are assessed using tracer kinetics (DTPA) and IOH clearance). Ultrasonic techniques, based on measurements of acoustic backscatter coefficients and parameters derived from these measurements, are sensitive to microscopic changes in the tissue morphology. Elasticity imaging is used to study the changes in the tissue macrostructure. All acoustic measurements are made using a state-of-the-art clinical imaging system (Siemens Elegra). Our results show that ultrasonic techniques are very sensitive to early changes in renal microstructure and macrostructure. Ultrasound can be used to detect changes in the renal cortex long before there is a measurable loss of renal function. These techniques are also useful for monitoring the progression of the disease. Most importantly, these techniques are noninvasive and directly applicable to humans.

  3. Creutzfeldt-Jakob disease: updated diagnostic criteria, treatment algorithm, and the utility of brain biopsy.

    PubMed

    Manix, Marc; Kalakoti, Piyush; Henry, Miriam; Thakur, Jai; Menger, Richard; Guthikonda, Bharat; Nanda, Anil

    2015-11-01

    Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative condition with a rapid disease course and a mortality rate of 100%. Several forms of the disease have been described, and the most common is the sporadic type. The most challenging aspect of this disease is its diagnosis-the gold standard for definitive diagnosis is considered to be histopathological confirmation-but newer tests are providing means for an antemortem diagnosis in ways less invasive than brain biopsy. Imaging studies, electroencephalography, and biomarkers are used in conjunction with the clinical picture to try to make the diagnosis of CJD without brain tissue samples, and all of these are reviewed in this article. The current diagnostic criteria are limited; test sensitivity and specificity varies with the genetics of the disease as well as the clinical stage. Physicians may be unsure of all diagnostic testing available, and may order outdated tests or prematurely request a brain biopsy when the diagnostic workup is incomplete. The authors review CJD, discuss the role of brain biopsy in this patient population, provide a diagnostic pathway for the patient presenting with rapidly progressive dementia, and propose newer diagnostic criteria.

  4. Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes.

    PubMed

    Hamar, G Brent; Rula, Elizabeth Y; Coberley, Carter; Pope, James E; Larkin, Shaun

    2015-04-22

    To evaluate the longitudinal value of a chronic disease management program, My Health Guardian (MHG), in reducing hospital utilization and costs over 4 years. The MHG program provides individualized support via telephonic nurse outreach and online tools for self-management, behavior change and well-being. In follow up to an initial 18-month analysis of MHG, the current study evaluated program impact over 4 years. A matched-cohort analysis retrospectively compared MHG participants with heart disease or diabetes (treatment, N = 4,948) to non-participants (comparison, N = 28,520) on utilization rates (hospital admission, readmission, total bed days) and hospital claims cost savings. Outcomes were evaluated using regression analyses, controlling for remaining demographic, disease, and pre-program admissions or cost differences between the study groups. Over the 4 year period, program participation resulted in significant reductions in hospital admissions (-11.4%, P < 0.0001), readmissions (-36.7%, P < 0.0001), and bed days (-17.2%, P < 0.0001). The effect size increased over time for admissions and bed days. The relative odds of any admission and readmission over the 4 years were 27% and 45% lower, respectively, in the treatment group. Cumulative program savings from reduced hospital claims was $3,549 over 4-years; savings values for each program year were significant and increased with time (P = 0.003 to P < 0.0001). Savings calculations did not adjust for pooled costs (and savings) in Australia's risk equalization system for private insurers. Results confirm and extend prior program outcomes and support the longitudinal value of the MHG program in reducing hospital utilization and costs for individuals with heart disease or diabetes and demonstrate the increasing program effect with continued participation over time.

  5. Proximity to Disease and Perception of Utility: Physicians’ vs Patients’ Assessment of Treatment Options for Ulcerative Colitis

    PubMed Central

    Brown, Lindsay Kennedy; Waljee, Akbar K.; Higgins, Peter D. R.; Waljee, Jennifer F.; Morris, Arden M.

    2017-01-01

    BACKGROUND Physician values regarding the benefit of continued medical therapy vs colectomy for moderate ulcerative colitis have not been defined. If physicians perceive these states differently than patients, their therapeutic recommendations may not align with patient values. OBJECTIVE This study aimed to compare physician and patient willingness to trade life years with moderately active ulcerative colitis vs undergoing colectomy. DESIGN This survey of physicians’ and patients’ utility values used standardized scenarios for moderately active ulcerative colitis and colectomy. SETTING The investigation was conducted at a tertiary academic medical center. METHODS Gastroenterologists, colorectal surgeons, and patients with ulcerative colitis who were either living with moderate disease or were postcolectomy completed the survey. MAIN OUTCOME MEASURES Utility values were measured by the use of the time trade-off method. RESULTS We surveyed 17 physicians, 150 postcolectomy patients, and 69 patients with moderate ulcerative colitis. Utility values for ulcerative colitis and colectomy states were (0.87, 0.95), (0.86, 0.92), and (0.91, 0.91). On average, physicians and postcolectomy patients assessed the utility of life with ulcerative colitis more poorly than the postcolectomy state. Patients with moderately active ulcerative colitis who had not undergone colectomy viewed both health states equally. LIMITATIONS This study was limited by the physician subject sample size. CONCLUSIONS Patients living with moderate ulcerative colitis value the pre- and postcolectomy states differently than physicians and postcolectomy patients. Recognizing the differences between their own and patients’ values may help physicians to better counsel patients preoperatively. In addition, exposure to postcolectomy patients may help those with moderate disease who are weighing the comparative benefits of colectomy. PMID:22067181

  6. The Utility of Preliminary Patient Evaluation in a Febrile Respiratory Infectious Disease Unit outside the Emergency Department.

    PubMed

    Kang, Jun Sik; Jhun, Byung Woo; Yoon, Hee; Lim, Seong Mi; Ko, Eunsil; Park, Joo Hyun; Hwang, Sung Yeon; Lee, Se Uk; Lee, Tae Rim; Cha, Won Chul; Shin, Tae Gun; Sim, Min Seob; Jo, Ik Joon

    2017-09-01

    A febrile respiratory infectious disease unit (FRIDU) with a negative pressure ventilation system was constructed outside the emergency department (ED) of the Samsung Medical Center in 2015, to screen for patients with contagious diseases requiring isolation. We evaluated the utility of the FRIDU during 1 year of operation. We analyzed 1,562 patients who were hospitalized after FRIDU screening between August 2015 and July 2016. The level of isolation recommended during their screening at the FRIDU was compared with the level deemed appropriate given their final diagnosis. Of the 1,562 patients screened at the FRIDU, 198 (13%) were isolated, 194 (12%) were reverse isolated, and 1,170 (75%) were not isolated. While hospitalized, 97 patients (6%) were confirmed to have a contagious disease requiring isolation, such as tuberculosis; 207 patients (13%) were confirmed to be immunocompromised and to require reverse isolation, mainly due to neutropenia; and the remaining 1,258 patients (81%) did not require isolation. The correlation coefficient for isolation consistency was 0.565 (P < 0.001). The sensitivity and negative predictive value of FRIDU screening for diagnosing contagious disease requiring isolation are 76% and 98%, respectively. No serious nosocomial outbreaks of contagious diseases occurred. During FRIDU screening, 114 patients were admitted to the resuscitation zone due to clinical instability, and three of these patients died. The initial isolation levels resulting from FRIDU screening were moderately well correlated with the isolation levels required by the final diagnosis, demonstrating the utility of pre-hospitalization screening units. However, the risks of deterioration during the screening process remain challenges. © 2017 The Korean Academy of Medical Sciences.

  7. Utility of MR enterography and ultrasound for the investigation of small bowel Crohn's disease.

    PubMed

    Bhatnagar, Gauraang; Von Stempel, Conrad; Halligan, Steve; Taylor, Stuart A

    2017-06-01

    Cross sectional Imaging plays an increasingly important role the diagnosis and management of Crohn's disease. Particular emphasis is placed on MRI and Ultrasound as they do not impart ionising radiation. Both modalities have reported high sensitivity for disease detection, activity assessment and evaluation of extra-luminal complications, and have positive effects on clinical decision making. International Guidelines now recommend MRI and Ultrasound in the routine management of Crohn's disease patients. This article reviews the current evidence base supporting both modalities with an emphasis on the key clinical questions. We describe current protocols, basic imaging findings and highlight areas in need of further research. 5 Technical Efficacy: Stage 4 J. MAGN. RESON. IMAGING 2017;45:1573-1588. © 2016 International Society for Magnetic Resonance in Medicine.

  8. The clinical utility of FibroScan® as a noninvasive diagnostic test for liver disease

    PubMed Central

    Wilder, Julius; Patel, Keyur

    2014-01-01

    An important aspect of managing chronic liver disease is assessing for evidence of fibrosis. Historically, this has been accomplished using liver biopsy, which is an invasive procedure associated with risk for complications and significant sampling and observer error, limiting the accuracy for determination of fibrosis stage. Hence, several serum biomarkers and imaging methods for noninvasive assessment of liver fibrosis have been developed. In this article, we review the current literature on an important noninvasive imaging modality to measure tissue elastography (FibroScan®). This ultrasound-based technique is now increasingly available in many countries and has been shown to be a reliable and safe noninvasive means of assessing disease severity in chronic liver disease of varying etiology. PMID:24833926

  9. Utility of whole exome sequencing in evaluation of juvenile motor neuron disease.

    PubMed

    Agarwal, Sonika; Potocki, Lorraine; Collier, Talia R; Woodbury, Suzanne L; Adesina, Adekunle M; Jones, Jeremy; Lotze, Timothy E

    2016-04-01

    This case report focuses on identifying novel mutations in juvenile motor neuron disease and emphasizes the significance of whole exome sequencing (WES). We report a 13-year-old Hispanic boy with rapidly progressive weakness, muscle atrophy, tremor, and tongue fasciculation, along with upper motor neuron findings of hyperactive gag reflex, hyperreflexia, and cog-wheel rigidity. Electromyography was suggestive of motor neuron disease. After an extensive evaluation, WES was performed. WES identified a heterozygous de novo variant of unknown clinical significance (VUS) in the fused-in-sarcoma gene (FUS) [c.1554_1557del]. Although initially reported as a VUS, the clinical data from our patient and data from the medical literature support that the variant is indeed disease-causing. The genetic etiology of amyotrophic lateral sclerosis (ALS) is heterogeneous and, as clinical sequencing for FUS was not available, WES was the only method by which a diagnosis of juvenile ALS could be made. © 2016 Wiley Periodicals, Inc.

  10. [Clinical utility of ulinastatin, urinary protease inhibitor in acute Kawasaki disease].

    PubMed

    Saji, Tsutomu

    2008-02-01

    Ulinastatin, a trypsin inhibitor, is useful as a first-line or a second-line treatment regimen including alternative therapy for IVIG-resistant or IVIG nonresponder Kawasaki disease (KD) patients. Mechanisms involving protections against tissue organs and endthelial cell and anti-inflammatory effects by ulinastatin, are dependent on the inhibition of PMN-derived elastase, tumor necrosis factor alpha (TNFalpha), and other proinflammatory cytokines/interleukins(IL-1, IL-6, IL-8). Ulinastatin also suppresses the activation of PMN cells, macrophages, and platelets. Although almost no statistical data related to the definitive effect in acute stage of KD, ulinastatin have shown possible effects, but not always, in a part of KD patients. The indications of clinical use include shock and pancreatitis. Off-label uses of ulinastatin have been reported in hematological, hepatic, renal, OB/Gy diseases and cardiovascular diseases including vasculitis syndromes. The efficacy of ulinastatin in aKD remained to be investigated.

  11. Understanding the economic burden of heart failure in China: impact on disease management and resource utilization.

    PubMed

    Huang, Jun; Yin, Hongjun; Zhang, Milun; Ni, Qian; Xuan, Jianwei

    2017-05-01

    This study has two objectives: (1) to examine healthcare resource utilization in heart failure (HF) patients; and (2) to examine the treatment costs associated with HF in China. The data used in this study was from the 2014 national insurance database sponsored by the China Health Insurance Research Association (CHIRA), that covers national urban employees and residents. ICD-10 codes and keywords indicating heart failure diagnoses were used to identify patients with heart failure. Drug utilization, hospital visits, re-admission, and treatment costs in different service categories were examined. A total of 7,847 patients were included in this analysis, of which 1,157 patients had a 1-year complete follow-up period. In total, 48.16% of patients received the combination treatment of angiotensin-converting-enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARB) and beta-blockers (BB); and 22.87% of patients received the combination treatment of ACEI/ARB, beta-blockers and Mineralocorticoid receptor antagonists (MRAs). The annual treatment cost per patient with HF diagnosis was RMB 28,974, of which 66% was for inpatient care. The cost on HF medications accounted for 8.2% of annual cost. Treatment cost was much higher in provincial-level municipalities than that of prefecture-level and other cities. Hospitalization is a major driver of HF treatment cost. Compared to the requirements in international treatment guidelines, HF standard of care medication treatment was under-utilized among HF patients in China. The high re-admission rate among Chinese patients indicates that the management of HF needs to be improved. The percentage of GDP spent on treating HF patients was much lower than that in the developed countries.

  12. The experimental autoimmune encephalomyelitis (EAE) model of MS: utility for understanding disease pathophysiology and treatment.

    PubMed

    Robinson, Andrew P; Harp, Christopher T; Noronha, Avertano; Miller, Stephen D

    2014-01-01

    While no single model can exactly recapitulate all aspects of multiple sclerosis (MS), animal models are essential in understanding the induction and pathogenesis of the disease and to develop therapeutic strategies that limit disease progression and eventually lead to effective treatments for the human disease. Several different models of MS exist, but by far the best understood and most commonly used is the rodent model of experimental autoimmune encephalomyelitis (EAE). This model is typically induced by either active immunization with myelin-derived proteins or peptides in adjuvant or by passive transfer of activated myelin-specific CD4+ T lymphocytes. Mouse models are most frequently used because of the inbred genotype of laboratory mice, their rapid breeding capacity, the ease of genetic manipulation, and availability of transgenic and knockout mice to facilitate mechanistic studies. Although not all therapeutic strategies for MS have been developed in EAE, all of the current US Food and Drug Administration (FDA)-approved immunomodulatory drugs are effective to some degree in treating EAE, a strong indicator that EAE is an extremely useful model to study potential treatments for MS. Several therapies, such as glatiramer acetate (GA: Copaxone), and natalizumab (Tysabri), were tested first in the mouse model of EAE and then went on to clinical trials. Here we discuss the usefulness of the EAE model in understanding basic disease pathophysiology and developing treatments for MS as well as the potential drawbacks of this model.

  13. Living Alone with Alzheimer's Disease: Effects on Health and Social Service Utilization Patterns.

    ERIC Educational Resources Information Center

    Webber, Pamela Arnsberger; And Others

    1994-01-01

    Examined differences in patterns of service use between persons with probable or possible Alzheimer's disease who lived alone (n=439) versus those living with others (n=2,026). Found that those living alone were more likely female, poor, older, and had milder cognitive impairments; less likely to use medical services; and more likely to use…

  14. Utilization of Telehealth Technology to Develop and Implement a Comprehensive Management Initiative for Chronic Diseases

    DTIC Science & Technology

    2012-10-01

    alone or in various combinations . The program indicates which dose or doses of medications should be increased or decreased, when there has been... combined best educational practices with telehealth technology offered a promising solution to this problem. Thus, the CMICD evaluated the... combination of poor access to and compliance with periodic eye examinations that target early detection of sight- threatening eye disease. Even in

  15. (F)Utility of invasive haemodynamic measurements to guide percutaneous intervention in chronic coronary artery disease.

    PubMed

    Seiler, Christian

    2015-01-01

    Percutaneous coronary intervention (PCI) in chronic stable coronary artery disease has not been shown to reduce the incidence of myocardial infarction or death. There is, however, evidence that the outcome from PCI is dependent on the amount of myocardial ischaemia. This review provides an overview of coronary circulatory pathophysiology and focuses on fractional flow reserve from a semantical, conceptual and practical point of view.

  16. Reduced carbon utilization, competitive colonization of the spermosphere, and disease suppression by Enterobacter cloacae

    USDA-ARS?s Scientific Manuscript database

    De Wit Replacement series and disease suppression experiments with a collection of nutritional mutants of E. cloacae 501R3 are being used to determine the role of reduced carbon compounds found in seed exudate during beneficial activities by this bacterium. Mutants A-11, M2, and M43 contain single ...

  17. Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model.

    PubMed

    Delon, Sandra; Mackinnon, Blair

    2009-01-01

    Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.

  18. Design and utilization of macrophage and vascular smooth muscle cell co-culture systems in atherosclerotic cardiovascular disease investigation.

    PubMed

    Zuniga, Mary C; White, Sharla L Powell; Zhou, Wei

    2014-10-01

    Atherosclerotic cardiovascular disease has been acknowledged as a chronic inflammatory condition. Monocytes and macrophages lead the inflammatory pathology of atherosclerosis whereas changes in atheromatous plaque thickness and matrix composition are attributed to vascular smooth muscle cells. Because these cell types are key players in atherosclerosis progression, it is crucial to utilize a reliable system to investigate their interaction. In vitro co-culture systems are useful platforms to study specific molecular mechanisms between cells. This review aims to summarize the various co-culture models that have been developed to investigate vascular smooth muscle cell and monocyte/macrophage interactions, focusing on the monocyte/macrophage effects on vascular smooth muscle cell function.

  19. Clinical utility of ductus venosus flow in fetuses with right-sided congenital heart disease.

    PubMed

    Arya, Bhawna; Krishnan, Anita; Donofrio, Mary T

    2014-09-01

    Abnormal ductus venosus flow is associated with fetal compromise and can be present in right-sided congenital heart disease. We hypothesized that the ductus venosus flow pattern in fetuses with obstructive right-sided congenital heart disease will have abnormal flow at baseline. Those with nonobstructive disease will have normal flow at baseline. We further hypothesized that abnormal ductus venosus flow will predict fetal compromise. We conducted a retrospective review of fetuses with right-sided congenital heart disease. Ductus venosus measurements included the presence of atrial reversal, velocity time integral, and peak velocity index. Fetuses were separated into those with obstructive (group 1) and nonobstructive (group 2) lesions. Compromise was defined as fetal distress (pericardial effusion, hydrops, or left ventricular dilatation/dysfunction) or death (fetal/neonatal mortality). Sixty fetuses with right-sided congenital heart disease were identified (mean gestational age ± SD, 24.2 ± 5.4 weeks; group 1, n = 45; group 2, n = 15). Ductus venosus reversal was more often present (49% versus 13%; P = .017), and the peak velocity index was significantly higher (1.39 ± 0.67 versus 0.98 ± 0.33; P= .026) in group 1. In group 1, ductus venosus reversal was more often present (93% versus 32%; P < .001), and the peak velocity index was significantly higher (1.87 ± 0.67 versus 1.12 ± 0.53; P< .001) in compromised fetuses. In this group, a peak velocity index higher than 1.57 predicted compromise with 93% sensitivity and 81% specificity. In group 2, ductus venosus reversal was rarely present (n = 2) and was not found in any fetuses who died. Fetuses with obstructive right-sided congenital heart disease have ductus venosus reversal at baseline; an abnormal peak velocity index can be used to predict compromise. Fetuses with nonobstructive disease rarely have ductus venosus reversal; the peak velocity index cannot be used to predict outcomes in this group. © 2014 by

  20. Satellite Servicing Technology Development Missions

    NASA Technical Reports Server (NTRS)

    Middleton, R.; Waltz, D.; Schrock, S.

    1984-01-01

    A new capability regarding the U.S. space efforts will be related to the servicing of satellites in orbit utilizing first-generation space station as the collection point or base for Shuttle-delivered payloads. Orbital maneuvering vehicles could move payloads or spacecraft assembled at the Shuttle/space station terminus to other earth orbit locations. It is assumed that such a capability will be initially available in the early 1990's. The benefits provided by satellite servicing in orbit are discussed, taking into account extended satellite lifetimes, lower acquisition cost, improved satellite performance, the possibility to change a satellite's mission, optimized science, and higher satellite reliability. The requirements for Satellite Servicing Technology Development Missions (TDMs) are considered. It is found that existing technology is insufficient, in various areas, to perform the servicing operations. A list is provided of critical technologies which must be developed.

  1. Radiocommunications for meteorological satellite systems

    NASA Technical Reports Server (NTRS)

    Walton, B. A.

    1975-01-01

    A general overview is presented of the spectrum utilization and frequency requirements of present and planned meteorological satellite programs. The sensors, and TIROS operational systems are discussed along with the Nimbus and Synchronous Meteorological Satellites. STORMSAT, SEASAT, and the Spacelab are briefly described.

  2. The utility of serum CA-125 in predicting extra-uterine disease in apparent early-stage endometrial cancer.

    PubMed

    Nicklin, James; Janda, Monika; Gebski, Val; Jobling, Thomas; Land, Russell; Manolitsas, Tom; McCartney, Anthony; Nascimento, Marcelo; Perrin, Lewis; Baker, Jannah F; Obermair, Andreas

    2012-08-15

    Surgical staging in early-stage uterine cancer is controversial. Preoperative serum CA-125 may be of clinical value in predicting the presence of extra-uterine disease in patients with apparent early-stage endometrial cancer. Between October 6, 2005, and June 17, 2010, 760 patients were enrolled in an international, multicentre, prospective randomized trial (LACE) comparing laparotomy with laparoscopy in the management of endometrial cancer apparently confined to the uterus. Of these, 657 patients with endometrial adenocarcinoma had a preoperative serum CA-125 value recorded. Multiple cross-validation analysis was undertaken to correlate preoperative serum CA-125 with stage of disease (Stage I vs. Stage II+) after surgery. Patients' median preoperative serum CA-125 was 14 U/ml. A cutoff point of 30 U/ml was associated with the smallest misclassification error, and using this cutoff, 98 patients (14.9%) had elevated CA-125 levels. Of those, 36 (36.7%) had evidence of extra-uterine disease. Of the 116 patients (17.7%) with evidence of extra-uterine disease, 31.0% had an elevated CA-125 level. On univariate and multivariable logistic regression analysis, only preoperative CA-125 level, but no other preoperative clinical characteristics were found to be associated with extra-uterine spread of disease. Utilizing a cutoff point of 30 U/ml achieved a sensitivity, specificity, positive predictive value and negative predictive value of 31.0, 88.5, 36.7 and 85.7%, respectively. Elevated CA-125 above 30 U/ml in patients with apparent early-stage disease is a risk factor for the presence of extra-uterine disease and may assist clinicians in the management of patients with clinical Stage I endometrial cancer.

  3. Satellites in Canadian broadcasting

    NASA Astrophysics Data System (ADS)

    Siocos, C. A.

    The involvement of Canadian broadcasting and related enterprises in satellite telecommunications is surveyed. This includes point-to-point transmissions and direct ones to the general public. The mode of such utilizations is indicated in both these cases. For the forthcoming DBS systems the many types of service offerings and utilization concepts under discussion elasewhere are presented as well as the business prospects and regulatory climate offering them.

  4. Illness-specific anxiety: implications for functioning and utilization of medical services in adolescents with inflammatory bowel disease.

    PubMed

    Reigada, Laura C; Bruzzese, Jean-Marie; Benkov, Keith J; Levy, Joseph; Waxman, Amanda R; Petkova, Eva; Warner, Carrie Masia

    2011-07-01

    PURPOSE. Adolescents with inflammatory bowel disease (IBD) may be at heightened risk for developing anxiety and depression. This cross-sectional pilot study examined the relationship between anxiety and depression and health-related behaviors. METHODS. Thirty-six adolescents with diagnosed IBD, ages 12-17, and their parents were recruited from two pediatric gastroenterology medical centers. RESULTS. Clinical levels of anxiety (22%) and depressive symptoms (30%) were reported by patients. Regression analyses revealed that IBD-specific anxiety was significantly associated with greater utilization of medical services and worsened psychosocial functioning. PRACTICE IMPLICATIONS. Results provide preliminary support that IBD-specific anxiety may play an important role in disease management, yet concerns are rarely systematically assessed by health professionals. © 2011, Wiley Periodicals, Inc.

  5. Satellite Teleconferencing in the Caribbean.

    ERIC Educational Resources Information Center

    Sankar, Hollis C.

    1985-01-01

    Discusses the need for, and the development, use, and future trends of, the University of the West Indies Distance Teaching Experiment, which utilizes telephone and communications satellite technology teleconferencing to extend educational opportunities to the peoples of the Caribbean. (MBR)

  6. Satellite Teleconferencing in the Caribbean.

    ERIC Educational Resources Information Center

    Sankar, Hollis C.

    1985-01-01

    Discusses the need for, and the development, use, and future trends of, the University of the West Indies Distance Teaching Experiment, which utilizes telephone and communications satellite technology teleconferencing to extend educational opportunities to the peoples of the Caribbean. (MBR)

  7. Utilization of downscaled microwave satellite data and GRACE Total Water Storage anomalies for improving streamflow prediction in the Lower Mekong Basin

    NASA Astrophysics Data System (ADS)

    Lakshmi, V.; Gupta, M.; Bolten, J. D.

    2016-12-01

    The Mekong river is the world's eighth largest in discharge with draining an area of 795,000 km² from the Eastern watershed of the Tibetan Plateau to the Mekong Delta including, Myanmar, Laos PDR, Thailand, Cambodia, Vietnam and three provinces of China. The populations in these countries are highly dependent on the Mekong River and they are vulnerable to the availability and quality of the water resources within the Mekong River Basin. Soil moisture is one of the most important hydrological cycle variables and is available from passive microwave satellite sensors (such as AMSR-E, SMOS and SMAP), but their spatial resolution is frequently too coarse for effective use by land managers and decision makers. The merging of satellite observations with numerical models has led to improved land surface predictions. Although performance of the models have been continuously improving, the laboratory methods for determining key hydraulic parameters are time consuming and expensive. The present study assesses a method to determine the effective soil hydraulic parameters using a downscaled microwave remote sensing soil moisture product based on the NASA Advanced Microwave Scanning Radiometer (AMSR-E). The soil moisture downscaling algorithm is based on a regression relationship between 1-km MODIS land surface temperature and 1-km Moderate Resolution Imaging Spectroradiometer (MODIS) Normalized Difference Vegetation Index (NDVI) to produce an enhanced spatial resolution ASMR-E-based soil moisture product. Since the optimized parameters are based on the near surface soil moisture information, further constraints are applied during the numerical simulation through the assimilation of GRACE Total Water Storage (TWS) within the land surface model. This work improves the hydrological fluxes and the state variables are optimized and the optimal parameter values are then transferred for retrieving hydrological fluxes. To evaluate the performance of the system in helping improve

  8. The potential utility of tight junction regulation in celiac disease: focus on larazotide acetate.

    PubMed

    Khaleghi, Shahryar; Ju, Josephine M; Lamba, Abhinav; Murray, Joseph A

    2016-01-01

    Celiac disease (CD) is a common chronic immune disease triggered by gluten. Gliadin peptides pass through the epithelial layers, either paracellularly or transcellularly, to launch a potent adaptive immune response in the lamina propria. This aberrant immune response leads to diverse gastrointestinal and extra-gastrointestinal symptoms. Currently, the only treatment for CD is a strict lifelong adherence to a gluten-free diet (GFD), which can be challenging. An early effect of gluten in CD is an increase in gut permeability. Larazotide acetate, also known as AT-1001, is a synthetic peptide developed as a permeability regulator primarily targeting CD. In vitro studies indicate that larazotide acetate is capable of inhibiting the actin rearrangement caused by gliadin and clinical studies have been conducted using this peptide as a therapy for CD.

  9. Bayesian analysis versus discriminant function analysis: their relative utility in the diagnosis of coronary disease.

    PubMed

    Detrano, R; Leatherman, J; Salcedo, E E; Yiannikas, J; Williams, G

    1986-05-01

    Both Bayesian analysis assuming independence and discriminant function analysis have been used to estimate probabilities of coronary disease. To compare their relative accuracy, we submitted 303 subjects referred for coronary angiography to stress electrocardiography, thallium scintigraphy, and cine fluoroscopy. Severe angiographic disease was defined as at least one greater than 50% occlusion of a major vessel. Four calculations were done: (1) Bayesian analysis using literature estimates of pretest probabilities, sensitivities, and specificities was applied to the clinical and test data of a randomly selected subgroup (group I, 151 patients) to calculate posttest probabilities. (2) Bayesian analysis using literature estimates of pretest probabilities (but with sensitivities and specificities derived from the remaining 152 subjects [group II]) was applied to group I data to estimate posttest probabilities. (3) A discriminant function with logistic regression coefficients derived from the clinical and test variables of group II was used to calculate posttest probabilities of group I. (4) A discriminant function derived with the use of test results from group II and pretest probabilities from the literature was used to calculate posttest probabilities of group I. Receiver operating characteristic curve analysis showed that all four calculations could equivalently rank the disease probabilities for our patients. A goodness-of-fit analysis suggested the following relationship between the accuracies of the four calculations: (1) less than (2) approximately equal to (4) less than (3). Our results suggest that data-based discriminant functions are more accurate than literature-based Bayesian analysis assuming independence in predicting severe coronary disease based on clinical and noninvasive test results.

  10. Chronic disease self-management education courses: utilization by low-income, middle-aged participants.

    PubMed

    Horrell, Lindsey N; Kneipp, Shawn M; Ahn, SangNam; Towne, Samuel D; Mingo, Chivon A; Ory, Marcia G; Smith, Matthew Lee

    2017-06-27

    Individuals living in lower-income areas face an increased prevalence of chronic disease and, oftentimes, greater barriers to optimal self-management. Disparities in disease management are seen across the lifespan, but are particularly notable among middle-aged adults. Although evidence-based Chronic Disease Self-management Education courses are available to enhance self-management among members of this at-risk population, little information is available to determine the extent to which these courses are reaching those at greatest risk. The purpose of this study is to compare the extent to which middle-aged adults from lower- and higher-income areas have engaged in CDSME courses, and to identify the sociodemographic characteristics of lower-income, middle aged participants. The results of this study were produced through analysis of secondary data collected during the Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative. During this initiative, data was collected from 100,000 CDSME participants across 45 states within the United States, the District of Columbia, and Puerto Rico. Of the entire sample included in this analysis (19,365 participants), 55 people lived in the most impoverished counties. While these 55 participants represented just 0.3% of the total study sample, researchers found this group completed courses more frequently than participants from less impoverished counties once enrolled. These results signal a need to enhance participation of middle-aged adults from lower-income areas in CDSME courses. The results also provide evidence that can be used to inform future program delivery choices, including decisions regarding recruitment materials, program leaders, and program delivery sites, to better engage this population.

  11. Utilization of Telehealth Technology to Develop and Implement a Comprehensive Management Initiative for Chronic Diseases

    DTIC Science & Technology

    2011-10-01

    Diabetic eye disease is the leading cause of blindness among working-age adults, yet it is largely preventable with timely diagnosis and treatment ... Diabetic Retinopathy Study Research Group, 1981; Early Treatment Diabetic Retinopathy Research Group, 1991). Diabetes -related vision loss is often...with mydriatic seven-standard field Early Treatment Diabetic Retinopathy Study (ETDRS) protocol photography (Bursell et al., 2001) and with dilated

  12. Health service utilization among Alzheimer's disease patients: evidence from managed care.

    PubMed

    Frytak, Jennifer R; Henk, Henry J; Zhao, Yang; Bowman, Lee; Flynn, Jennifer A; Nelson, Michael

    2008-09-01

    The objective of this study was to assess the disease burden of Alzheimer's disease (AD) in a commercial managed care setting by comparing direct health care costs and adverse event outcomes between patients with AD and without AD. The study design used eligibility, medical, and pharmacy claims data from a large, national, geographically diverse, fee-for-service U.S. managed health plan. Commercially insured patients aged 65 years and older with a pharmacy benefit with evidence of AD (n = 4,450) and a control group without AD (n = 13,650) were matched by age, gender, plan location, and length of enrollment. Adverse event outcomes, comorbid conditions, and annualized health care costs were compared. Incremental costs were calculated by using a two-part model to estimate the burden of illness; incremental cost confidence intervals were estimated by bootstrap analysis. Patients with AD had generally higher health care costs and higher risk of acute adverse outcomes than the control cohort. Annual adjusted total health care costs per patient were approximately $1,418 greater for the AD cohort. Patients with AD had an unadjusted fracture risk of 14.6% versus 6.2% in the matched cohort and accidental injury/falls risk of 27.4% versus 11.4%. Few studies have examined the disease burden of AD in commercial managed care settings. Similar to results of comparative studies with Medicare data, the disease burden is greater for patients with AD compared with a matched control cohort, with a different mix and a greater number of comorbid health care conditions partially accounting for this difference. As membership in commercial and Medicare managed care plans increases, plans will need to develop effective mechanisms to manage the health care of high-risk, high-cost patients with AD.

  13. Adding Specialized Clinics for Remote-Dwellers with Chronic Kidney Disease: A Cost-Utility Analysis

    PubMed Central

    Wiebe, Natasha; Klarenbach, Scott W.; Chui, Betty; Ayyalasomayajula, Bharati; Hemmelgarn, Brenda R.; Jindal, Kailash; Manns, Braden; Tonelli, Marcello

    2012-01-01

    Summary Background and objectives This study aimed to determine whether opening a new clinic in a remote region would be a cost-effective means of improving care for remote-dwellers with CKD. Design, setting, participants, & measurements This study is a cost-utility analysis from a public payer’s perspective over a lifetime horizon, using administrative data from a large cohort of adults with stage 3b-4 CKD in Alberta, Canada. The association between the distance from each simulated patient’s residence and the practice location of the closest nephrologist and clinical outcomes (quality of care, hospitalization, dialysis, and death) were examined. A Markov 6-month cycle economic decision model was analyzed; estimates of the effect of a new clinic were based on the association between residence location, resource use, and outcomes. Costs are reported in 2009 Canadian dollars. Results The costs for equipping and operating a clinic for 321 remote-dwelling patients were estimated at $25,000 and $250,000/yr, respectively. The incremental cost-utility ratios (ICURs) ranged from $4000 to $8000/quality-adjusted life-year under most scenarios. However, if reducing distance to nephrologist care does not alter mortality or hospitalization among remote-dwellers, the cost-effectiveness becomes less attractive. All other one-way sensitivity analyses had negligible effects on the ICUR. Conclusions Given the low costs of equipping and operating new clinics, and the very attractive ICUR relative to other currently funded interventions, establishing new clinics for remote-dwellers could play an important role in efficiently improving outcomes for patients with CKD. High-quality controlled studies are required to confirm this hypothesis. PMID:22076876

  14. Utilization of sialic acid as a coreceptor is required for reovirus-induced biliary disease

    PubMed Central

    Barton, Erik S.; Youree, Bryan E.; Ebert, Daniel H.; Forrest, J. Craig; Connolly, Jodi L.; Valyi-Nagy, Tibor; Washington, Kay; Wetzel, J. Denise; Dermody, Terence S.

    2003-01-01

    Infection of neonatal mice with some reovirus strains produces a disease similar to infantile biliary atresia, but previous attempts to correlate reovirus infection with this disease have yielded conflicting results. We used isogenic reovirus strains T3SA– and T3SA+, which differ solely in the capacity to bind sialic acid as a coreceptor, to define the role of sialic acid in reovirus encephalitis and biliary tract infection in mice. Growth in the intestine was equivalent for both strains following peroral inoculation. However, T3SA+ spread more rapidly from the intestine to distant sites and replicated to higher titers in spleen, liver, and brain. Strikingly, mice infected with T3SA+ but not T3SA– developed steatorrhea and bilirubinemia. Liver tissue from mice infected with T3SA+ demonstrated intense inflammation focused at intrahepatic bile ducts, pathology analogous to that found in biliary atresia in humans, and high levels of T3SA+ antigen in bile duct epithelial cells. T3SA+ bound 100-fold more efficiently than T3SA– to human cholangiocarcinoma cells. These observations suggest that the carbohydrate-binding specificity of a virus can dramatically alter disease in the host and highlight the need for epidemiologic studies focusing on infection by sialic acid–binding reovirus strains as a possible contributor to the pathogenesis of neonatal biliary atresia. PMID:12813018

  15. Immunofluorescence Patterns in Selected Dermatoses, Including Blistering Skin Diseases Utilizing Multiple Fluorochromes

    PubMed Central

    Abreu-Velez, Ana Maria; Calle-Isaza, Juliana; Howard, Michael S.

    2015-01-01

    Background: Autoimmune vesiculobullous disorders represent a heterogeneous group of dermatoses whose diagnosis is made based on clinical history, histologic features, and immunopathologic features. The most commonly used techniques for the diagnosis of these diseases are direct and indirect immunofluorescence (DIF and IIF), including salt-split processing. NaCl split skin is used to determine the level of blister formation, and the localization of autoantibodies relative to the split. Classically, immunofluorescence has been performed with one fluorochrome in the diagnosis of autoimmune bullous skin diseases. Aims: To compare DIF and IIF of the skin, using a single fluorochrome versus multiple fluorochromes. Materials and Methods: We studied 20 autoimmune skin disease cases using fluorescein isothiocyanate (FITC) alone, in comparison to multiple fluorochromes (with or without DNA counterstaining). Results: The use of multiple fluorochromes helped to simultaneously visualize reactivity in multiple skin areas, in contrast to using FITC alone. Conclusions: Using multiple fluorochromes allows simultaneous labeling of two or more antigens within the same cell/or tissue section, assists in colocalization of unknown antigens with known molecules, and helps in ruling out “background” staining. PMID:26605203

  16. Zotarolimus-eluting stent utilization in small-vessel coronary artery disease (ZEUS).

    PubMed

    Jim, Man-Hong; Yiu, Kai-Hang; Fung, Raymond Chi-Yan; Ho, Hee-Hwa; Ng, Andrew Kei-Yan; Siu, Chung-Wah; Chow, Wing-Hing

    2014-01-01

    The role of the second-generation zotarolimus-eluting stent RESOLUTE in small-vessel coronary artery disease is unclear. The aim of this study was examine the angiographic results of RESOLUTE in de novo coronary lesions of ≥50 % diameter stenosis in target vessels ≤2.5 mm. From August 2008 to April 2010, 142 symptomatic patients with 159 lesions who fitted the inclusion criteria were treated with RESOLUTE. The mean age of patients was 66 ± 10 years, with male predominance (66 %). Diabetes mellitus was found in 62 (43.7 %) patients, whereas multivessel disease was observed in 105 (73.9 %). The mean stent size and length used were 2.33 ± 0.13 and 22 ± 8 mm, respectively. Follow-up angiography was performed on 143 (89.9 %) lesions in 127 (89.4 %) patients at a mean of 10.3 ± 3.6 months. Angiographic restenosis was found in 9 (6.3 %) lesions; the late loss was 0.26 ± 0.34 mm. At 1-year follow-up there were four cardiovascular deaths, two nonfatal myocardial infarctions, and six repeated revascularizations. The resultant major adverse cardiac event rate was 8.5 %. The use of RESOLUTE to treat small-vessel disease is associated with good clinical and angiographic outcomes at 1 year.

  17. Disease constraints for utilization of the African buffalo (Syncerus caffer) on game ranches in Zambia.

    PubMed

    Munang'andu, Hetron M; Munag'andu, Hetron M; Siamudaala, Victor M; Nambota, Andrew; Bwalya, John M; Munyeme, Musso; Mweene, Aaron S; Takada, Ayato; Kida, Hiroshi

    2006-05-01

    Eco-tourism depending on wildlife is becoming increasingly profitable and landowners are beginning to favor game farming and ecotourism. In these areas, large-scale translocation of wildlife involves a diversity of species and large populations. The African buffalo (Syncerus caffer) is one of the major tourist attractions in Zambia. It accounts for 8.7% and 12.4% of the total animal species hunted in the Game Management Areas and the total hunting revenue earned in Zambia, respectively. It is ecologically an important animal species essential for the purpose of habitat control and facilitating the provision of suitable grazing pastures. However, the rearing of the African buffalo on game ranches has been hampered by its carrier state of the Southern Africa Terroritory (SAT) serotypes of foot and mouth disease virus (FMD). The African buffalo is also known to be a carrier of Theileria parva lawrencei, the causative agent of corridor disease (CD) that continues to have devastating effects on the livestock industry in Zambia. In addition, the importation of buffaloes from countries with populations endemic to bovine tuberculosis is highly restricted. Veterinary regulations in Zambia, strongly advocate against the translocation of buffaloes from protected areas to private ranches for disease control purposes thereby mounting a considerable constraint on the economic and ecological viability of the industry. It is hoped that this review will motivate the relevant government authorities in exploiting ways in which this animal species play a central role in eco-tourism.

  18. Clinical utility of cerebrospinal fluid biomarkers in the diagnosis of early Alzheimer’s disease

    PubMed Central

    Blennow, Kaj; Dubois, Bruno; Fagan, Anne M.; Lewczuk, Piotr; de Leon, Mony J.; Hampel, Harald

    2015-01-01

    Several potential disease-modifying drugs for Alzheimer’s disease (AD) have failed to show any effect on disease progression in clinical trials, conceivably because the AD subjects are already too advanced to derive clinical benefit from treatment and because diagnosis based on clinical criteria alone introduces a high misdiagnosis rate. Thus, well-validated biomarkers for early detection and accurate diagnosis are crucial. Low cerebrospinal fluid (CSF) concentrations of the amyloid-β (Aβ1-42) peptide, in combination with high total tau and phosphorylated tau, are sensitive and specific biomarkers highly predictive of progression to AD dementia in patients with mild cognitive impairment. However, interlaboratory variations in the results seen with currently available immunoassays are of concern. Recent worldwide standardization efforts and quality control programs include standard operating procedures for both preanalytical (e.g., lumbar puncture and sample handling) and analytical (e.g., preparation of calibration curve) procedures. Efforts are also ongoing to develop highly reproducible assays on fully automated instruments. These global standardization and harmonization measures will provide the basis for the generalized international application of CSF bio-markers for both clinical trials and routine clinical diagnosis of AD. PMID:24795085

  19. Utility of renal biopsy in the clinical management of renal disease.

    PubMed

    Dhaun, Neeraj; Bellamy, Christopher O; Cattran, Daniel C; Kluth, David C

    2014-05-01

    Characterizing chronic kidney disease (CKD) at all stages is an essential part of rational management and the renal biopsy plays a key role in defining the processes involved. There remain no global guidelines available to the renal community on indications for this important diagnostic, prognostic, and relatively safe test. Although most nephrologists recognize several clear indications for a renal biopsy, it is still underutilized. It not only helps the clinician to manage the patient with CKD, but it can also help clarify the epidemiology of CKD, and aid research into the pathobiology of disease with the aim of discovering new therapies. It may be useful for instance in elderly patients with CKD, those with diabetes and presumed 'hypertensive nephropathy', and in some patients with advanced CKD as part of the pretransplant work-up. In some populations (for example, immunoglobulin A nephropathy and ANCA vasculitis), renal biopsy allows disease classification that may predict CKD progression and response to therapy. For the individual, interval renal biopsy may be of use in providing ongoing therapeutic and prognostic information. Molecular advances will change the landscape of renal pathology and add a new dimension to the diagnostic precision of kidney biopsy. Organizing the multiplicity of information available in a renal biopsy to maximize benefits to the patient, as well as to the epidemiologist and researcher, is one of the challenges that face the nephrology community.

  20. Utility of Circulating MicroRNAs as Clinical Biomarkers for Cardiovascular Diseases

    PubMed Central

    Kondkar, Altaf A.; Abu-Amero, Khaled K.

    2015-01-01

    MicroRNAs (miRNAs) are small noncoding RNA molecules that regulate gene and protein expression by translational repression and/or mRNA degradation. miRNAs are implicated in the pathogenesis of various cardiovascular diseases and have become potential targets for therapeutic intervention. Their stability and presence in variety of readily accessible cell types including whole blood, serum, plasma, and other body fluids render them as potential source of a clinical biomarker. This review provides a brief overview of miRNA biogenesis and function, the diagnostic potential of circulating extracellular miRNA and their specific role in vivo in various cardiovascular settings, and their future perspective as clinical biomarkers. It is clearly evident from experimental studies that miRNAs are responsible for the regulation of several biological functions and alterations in cardiovascular diseases. Current data supports the concept of using circulating miRNAs as a biomarker in cardiovascular disease. It remains to be seen, however, whether circulating miRNAs can fulfil this role to improve risk and severity prediction. PMID:25710029

  1. Diagnostic utility of fine-needle aspiration cytology in the management of liver disease in a district hospital.

    PubMed

    Shiramba, T L; Lodenyo, H A; Kabanga, J M; Kuria, J K

    2010-04-01

    Fine needle aspiration (FNA) cytology is a cost effective technique of obtaining cellular specimens for diagnoses. It has many advantages over large needle core biopsies that makes it quite suitable for outpatient department and institutions without facilities for histopathology diagnosis. Any site of the body can be sampled with FNA technique. To assess the diagnostic utility of fine needle aspiration cytology technique in management of patients with liver disease in resource limited settings. Prospective cross sectional study. Patient evaluation and FNA aspiration were done in Murang'a and Machakos district hospitals and specimen staining and microscopy were done in Centre for Clinical Research, Kenya Medical Research Institute. Patients who were suspected to have liver disease were referred to the medical outpatient clinics in Murang'a and Machakos district hospitals for evaluation. In addition those on the medical wards in the two hospitals who were suspected to have liver disease were also evaluated. The patients with liver disease were identified after physical and abdominal ultrasound examination. Those with hepatomegaly were selected for the study. Liver fine needle aspiration was done using 21 gauge fine needle attached to a 10 ml syringe. Focal lesions were targeted as much as possible. Thin smears of specimens obtained were spread onto microscope slides which were then dropped into 95% ethanol and left for 30 min in order to fix the material. The slides were then removed, dried and transported to KEMRI where they were stained with Papanicolaou stain then evaluated on the light microscope. One hundred and twenty patients with suspected liver disease were evaluated in the two hospitals; 70 in Machakos and 50 in Murang'a. Fifty patients were identified to have liver disease and fine needle aspiration done aseptically. Twenty one (42%) of the 50 patients had malignant cells; 15(30%) of the 50 patients had necrotic material aspirates 2 (4%) shoved fatty

  2. Mobile satellite ranging

    NASA Technical Reports Server (NTRS)

    Silverberg, E. C.

    1978-01-01

    A brief review of the constraints which have limited satellite ranging hardware and an outline of the steps which are underway to improve the status of the equipment in this area are given. In addition, some suggestions are presented for the utilization of newer instruments and for possible future research and development work in this area.

  3. The Association of Optimism and Perceived Discrimination With Health Care Utilization in Adults With Sickle Cell Disease

    PubMed Central

    Stanton, Michael V.; Jonassaint, Charles R.; Bartholomew, Frederick B.; Edwards, Christopher; Richman, Laura; DeCastro, Laura; Williams, Redford

    2013-01-01

    Objective We evaluated the effect of perceived discrimination, optimism, and their interaction on health care utilization among African American adults with sickle cell disease (SCD). Methods Measures of optimism and perceived discrimination were obtained in 49 African American SCD patients. Multiple regression analyses controlling for sex and age tested effects of optimism and perceived discrimination on the number of emergency department visits (ED) and number and duration of hospitalizations over the past year. Results A perceived discrimination-optimism interaction was associated with number of emergency departments visits (b = .29, p = .052), number of hospitalizations (b = .36, p = .019), and duration of hospitalizations (b = .30, p = .045) such that those with high perceived discrimination/high optimism had the greatest health care utilization. Conclusions African American SCD patients with high perceived discrimination/high optimism had greater health care utilization than patients who reported either low perceived discrimination or low optimism. This study suggests that patient personality and coping styles should be considered when evaluating the effects of stress on SCD-related outcomes. PMID:21141295

  4. Utility of cardiac biomarkers during adulticide treatment of heartworm disease (Dirofilaria immitis) in dogs.

    PubMed

    Carretón, E; Morchón, R; González-Miguel, J; Juste, M C; Simón, F; Montoya-Alonso, J A

    2013-10-18

    Heartworm disease (Dirofilaria immitis) is a parasitic disease of dogs and other carnivores, characterized by the presence of adult worms in the pulmonary arteries and right ventricle, leading to pulmonary hypertension which may progress to congestive heart failure. Cardiac biomarkers are biological parameters that can be objectively measured as indicators of pathological processes, or to assess the response to therapeutic interventions. To evaluate the myocardial damage during the adulticide treatment in 15 heartworm-infected dogs with ivermectin, doxycycline and melarsomine, measurements of cardiac troponin I (cTnI), myoglobin, MB isoenzyme of creatine kinase (CK-MB) and aspartate aminotransferase (AST) were carried out on days 0, 60 and afterwards weekly on days 67, 75, 82, 91, 106, 113 and 120. Dogs were divided by low parasite burden (n=9) and high parasite burden (n=6). On day 0, dogs with high worm burden showed increased cTnI concentrations (3.62 ± 4.78 ng/ml) while dogs with low worm burden had concentrations similar to those of healthy dogs (0.78 ± 0.22 ng/ml), CK-MB concentrations were increased only in dogs with high parasite burden as well (54.4 ± 54.2U/l) and 26.6% (4/15) of the dogs showed pathological concentrations of myoglobin. On day 91, most dogs showed pathological concentrations of myoglobin, CK-MB and AST, probably due to the myositis associated to the intramuscular injection of melarsomine. The rest of the measurements made in the study, the biomarkers concentrations were within normal values, except for cTnI in dogs with high parasite burden, which remained above reference concentrations for healthy dogs during all the study. The evaluation of cardiac biomarkers seems to be a helpful test in the assessment of the myocardium in dogs with heartworm disease during the adulticide treatment.

  5. A simple method for quantification of plasma globotriaosylsphingosine: Utility for Fabry disease.

    PubMed

    Talbot, Andrew; Nicholls, Kathy; Fletcher, Janice M; Fuller, Maria

    2017-09-01

    Fabry disease (FD) results from impaired globotriaosylceramide (Gb3) catabolism, due to a deficiency of the lysosomal hydrolase, α-galactosidase A (α-GalA). As a direct consequence, the deacetylated derivative, globotriaosylsphingosine (lyso-Gb3), is produced and contemporary evidence exemplifies its use as a biomarker. Here we developed a simple method to enable quantification of lyso-Gb3 in just 0.01mL of plasma and explored its concentration in a cohort of 73 Australian FD patients, as well as in individuals with other sphingolipidoses. In 2000 patients without FD, but with related metabolic conditions, lyso-Gb3 returned concentrations of <5pmol/mL. In the FD cohort, 53/60 patients with classical mutations returned lyso-Gb3 concentrations≥5pmol/mL whereas only 4/13 patients with "late-onset" mutations had lyso-Gb3≥5pmol/mL. Five females with normal α-GalA activity and genetically confirmed FD returned lyso-Gb3≥5pmol/mL. The prevalence of clinically significant disease including cardiomyopathy, nephropathy and cerebrovascular disease was congruent with higher lyso-Gb3 concentrations. Repeat testing was available for 51 patients-26 undergoing enzyme replacement therapy-and concentrations of lyso-Gb3 remained unaltered throughout 6-18 months independent of sex, mutation or treatment status. Our data suggest that the optimum use of lyso-Gb3 resides in laboratory confirmation of classical FD and for monitoring at least the initial response to therapeutic intervention. There is no evidence that lyso-Gb3 can inform on clinical events. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Genetic Literacy and Patient Perceptions of IBD Testing Utility and Disease Control: A Randomized Vignette Study of Genetic Testing

    PubMed Central

    Hooker, Gillian W.; Peay, Holly; Erby, Lori; Bayless, Theodore; Biesecker, Barbara B.; Roter, Debra L.

    2014-01-01

    Background Findings from inflammatory bowel disease (IBD) genome-wide association studies are being translated clinically into prognostic and diagnostic indicators of disease. Yet, patient perception and understanding of these tests and their applicability to providing risk information is unclear. The goal of this study was to determine, using hypothetical scenarios, whether patients with IBD perceive genetic testing to be useful for risk assessment, whether genetic test results impact perceived control, and whether low genetic literacy may be a barrier to patient understanding of these tests. Methods Two hundred fifty seven patients with IBD from the Johns Hopkins gastroenterology clinics were randomized to receive a vignette depicting either a genetic testing scenario or a standard blood testing scenario. Participants were asked questions about the vignette and responses were compared between groups. Results Perceptions of test utility for risk assessment were higher among participants responding to the genetic vignette (P < 0.001). There were no significant differences in perceptions of control over IBD after hypothetical testing between vignettes (P = 0.24). Participant responses were modified by genetic literacy, measured using a scale developed for this study. Participants randomized to the genetic vignette who scored higher on the genetic literacy scale perceived greater utility of testing for risk assessment (P = 0.008) and more control after testing (P = 0.02). Conclusions Patients with IBD perceive utility in genetic testing for providing information relevant to family members, and this appreciation is promoted by genetic literacy. Low genetic literacy among patients poses a potential threat to effective translation of genetic and genomic tests. PMID:24691112

  7. Clinical utility of a new endoscopic scoring system for Crohn’s disease

    PubMed Central

    Morise, Kazuhiro; Ando, Takafumi; Watanabe, Osamu; Nakamura, Masanao; Miyahara, Ryoji; Maeda, Osamu; Ishiguro, Kazuhiro; Hirooka, Yoshiki; Goto, Hidemi

    2015-01-01

    AIM: To evaluate the clinical value of the newly modified Simple Endoscopic Score for Crohn’s disease (mSES-CD). METHODS: Seventy-six Crohn’s disease (CD) patients who underwent transanal double balloon endoscopy (DBE) in our hospital between 2003 and 2012 were retrospectively reviewed. DBE is defined as small intestinal endoscopy using two attached balloons. We included patients with stenosis which hampered passage of the scope and those who underwent DBE with observation for at least 80 cm from the ileocecal valve. Our new mSES-CD assesses the endoscopic activity of two consecutive small intestinal segments located 0-40 cm and 40-80 cm from the ileocecal valve by DBE, in addition to the activity of four colorectal segments. To compare the usefulness of mSES-CD with SES-CD, we similarly divided the patients into two groups according to total mSES-CD score (low disease activity group, < 4; high disease activity group, ≥ 4). The clinical value of mSES-CD in predicting clinical outcome in patients with CD was evaluated using the occurrence of surgery after DBE as an endpoint. RESULTS: Median age of the 76 CD patients was 36 years (range, 16-71). Thirty-nine patients had stenosis which hampered passage of the DBE to 80 cm on the proximal side from the ileocecal valve. Median evaluable length of small intestine by DBE was 80 cm (range, 3-200). A total of 74 patients had one or more small intestinal lesions detected by DBE, of which 62 (83.8%) were within 80 cm of the ileocecal valve on the proximal side. Only two patients (2.7%) with proximal-side lesions more than 80 cm from the ileocecal valve did not have lesions within 80 cm. Patients with high mSES-CD scores showed significantly shorter surgery-free survival than those with low scores (P < 0.05). In contrast, surgery-free survival did not significantly differ between the low and high SES-CD groups (P > 0.05). Multivariate analysis by a Cox proportional hazards model identified mSES-CD as an independent

  8. Utilization of Feeding Tubes in the Management of Feline Chronic Kidney Disease.

    PubMed

    Ross, Sheri

    2016-11-01

    Esophagostomy feeding tubes are useful, and in many cases essential, for the comprehensive management of cats with moderate to advanced chronic kidney disease (CKD). They should be considered a lifelong therapeutic appliance to facilitate the global management of cats with CKD thus providing improved therapeutic efficacy and quality-of-life. Esophagostomy tubes facilitate the maintenance of adequate hydration and increase owner compliance by facilitating the administration of medications. Finally, feeding tubes provide a means to deliver a stage-appropriate dietary prescription for cats with CKD and maintain an adequate nutritional plane in a patient that otherwise would be subject to chronic wasting.

  9. Does response inhibition have pre- and postdiagnostic utility in Parkinson's disease?

    PubMed

    MacDonald, Hayley J; Byblow, Winston D

    2015-01-01

    Parkinson's disease (Pd) is the second most prevalent degenerative neurological condition worldwide. Improving and sustaining quality of life is an important goal for Parkinson's patients. Key areas of focus to achieve this goal include earlier diagnosis and individualized treatment. In this review the authors discuss impulse control in Pd and examine how measures of impulse control from a response inhibition task may provide clinically useful information (a) within an objective test battery to aid earlier diagnosis of Pd and (b) in postdiagnostic Pd, to better identify individuals at risk of developing impulse control disorders with dopaminergic medication.

  10. Utility of Computed Tomographic Enteroclysis/Enterography for the Assessment of Mucosal Healing in Crohn's Disease

    PubMed Central

    Hashimoto, Shinichi; Shimizu, Kensaku; Shibata, Hiroaki; Kanayama, Satoko; Tanabe, Ryo; Onoda, Hideko; Matsunaga, Naohumi; Sakaida, Isao

    2013-01-01

    Aim. When determining therapeutic strategy, it is important to diagnose small intestinal lesions in Crohn's disease (CD) precisely and to evaluate mucosal healing as well as clinical remission in CD. The purpose of this study was to compare findings from computed tomographic enteroclysis/enterography (CTE) with those from the mucosal surface and to determine whether the state of mucosal healing can be determined by CTE. Materials and Methods. Of the patients who underwent CTE for CD, 39 patients were examined whose mucosal findings could be confirmed by colonoscopy, capsule endoscopy, balloon endoscopy, or with the resected surgical specimens. Results. According to the CTE findings, patients were determined to be in the active CD group (n = 31) or inactive CD group (n = 8). The proportion of previous surgery, clinical remission, stenosis, and CDAI score all showed significant difference between groups. Mucosal findings showed an association with ulcer in 93.6% of active group patients but in only 12.5% of inactive group patients (P < 0.0001), whereas mucosal healing was found in 62.5% of inactive group patients but in only 3.2% of active group patients (P < 0.0001). Conclusion. CTE appeared to be a useful diagnostic method for assessment of mucosal healing in Crohn's disease. PMID:23710169

  11. Anterior-posterior and lateral hemispheric alterations in cortical glucose utilization in Alzheimer's disease

    SciTech Connect

    Friedland, T.F.; Budinger, T.F.; Jaqust, W.J.; Yano, Y.; Huesman, R.H.; Knittel, B.; Koss, E.; Ober, B.A.

    1984-01-01

    The anatomical and chemical features of Alzheimer's disease (AD) are not distributed evenly throughout the brain. However, the nature of this focality has not been well established in vivo. Dynamic studies using the Donner 280-Crystal Positron Tomograph with (F-18)2-fluorodeoxyglucose were performed in 17 subjects meeting current research criteria for AD, and in 7 healthy age-matched control subjects. Glucose metabolic rates in the temporal-parietal cortex are 27% lower in AD than in controls. Ratios of activity density reveal consistently lower metabolic rates in temporal-parietal than frontal cortex in the AD group, while healthy aged subjects have equal metabolic rates in the two areas. Similar findings have been reported by other laboratories. A major finding is a striking lateral asymmetry of cortical metabolism in AD which does not favor either hemisphere. (The asymmetry is 13% in the AD group, 3% in controls, p<.005.) This has not been previously reported in AD. The consistency with which anterior-posterior metabolic differences are found in AD suggests that the focality of the metabolic changes may be used to develop a noninvasive diagnostic test for the disorder. The metabolic asymmetry in AD may be compared to the clinical and pathological asymmetry found in Creutzfeldt-Jakob disease, and may represent an additional link between AD and the subacute spongiform encephalopathies.

  12. Evaluation of ventricular geometry and performance in congenital heart disease utilizing magnetic resonance imaging

    NASA Astrophysics Data System (ADS)

    Fogel, Mark A.

    1994-05-01

    We have recently embarked on a systematic evaluation of the regional and global mechanical processes of the systemic, morphologic right ventricle (RV) which is in either a single or dual chambered circulation as well as single left ventricles (LV). An MRI tagging technique which lays down 2 sets of parallel stripes perpendicular to each other on the myocardium as well as standard cine MRI were utilized. Finite strain analysis was applied to the grid lines to derive principle strains and the motion of the intersection points were tracked through systole to determine regional radial shortening and twist. Cine sequences were used to derive the various parameters of ventricular geometry and performance as well as visualizing flow profiles in the aorta. We noted a marked decrease in vol, EF, and CO in the Fontan group of patients when compared to other surgical subgroups. It is hypothesized that atrial stiffening by surgical placement of baffles may contribute to the observed changes in ventricular mechanics. Aortic flow profiles in the reconstructed aorta were noted to be heterogenous across the aortic diameter.

  13. Satellite RNAs and Satellite Viruses.

    PubMed

    Palukaitis, Peter

    2016-03-01

    Satellite RNAs and satellite viruses are extraviral components that can affect either the pathogenicity, the accumulation, or both of their associated viruses while themselves being dependent on the associated viruses as helper viruses for their infection. Most of these satellite RNAs are noncoding RNAs, and in many cases, have been shown to alter the interaction of their helper viruses with their hosts. In only a few cases have the functions of these satellite RNAs in such interactions been studied in detail. In particular, work on the satellite RNAs of Cucumber mosaic virus and Turnip crinkle virus have provided novel insights into RNAs functioning as noncoding RNAs. These effects are described and potential roles for satellite RNAs in the processes involved in symptom intensification or attenuation are discussed. In most cases, models describing these roles involve some aspect of RNA silencing or its suppression, either directly or indirectly involving the particular satellite RNA.

  14. α2-Heremans-schmid glycoprotein (fetuin A) downregulation and its utility in inflammatory bowel disease

    PubMed Central

    Manolakis, Anastassios C; Christodoulidis, Gregory; Kapsoritakis, Andreas N; Georgoulias, Panagiotis; Tiaka, Elisavet K; Oikonomou, Kostas; Valotassiou, Varvara J; Potamianos, Spyros P

    2017-01-01

    AIM To investigate the impact of inflammatory bowel disease (IBD) on α2-Heremans-Schmid Glycoprotein (AHSG/fetuin A) and potential associations with disease and patient characteristics. METHODS AHSG serum levels were determined in treatment-naïve newly-diagnosed patients, 96 with ulcerative colitis (UC), 84 with Crohn's disease (CD), 62 with diarrhea-predominant or mixed irritable bowel syndrome (IBS, D- and M- types) and 180 healthy controls (HC), by an enzyme linked immunosorbent assay (ELISA). All patients were followed for a minimum period of 3 years at the Gastroenterology Department of the University Hospital of Larissa, Greece. C-reactive protein (CRP), anti-glycan antibodies, anti-Saccharomyces cerevisiae mannan antibodies IgG, anti-mannobioside carbohydrate antibodies IgG, anti-laminariobioside carbohydrate antibodies IgG and anti-chitobioside carbohydrate antibodies IgA were also determined via immunonephelometry and ELISA, respectively. RESULTS The mean ± SE of serum AHSG, following adjustment for confounders, was 0.32 ± 0.02 g/L in IBD, 0.32 ± 0.03 g/L in CD and 0.34 ± 0.03 g/L in UC patients, significantly lower than in IBS patients (0.7 ± 0.018 g/L) and HC (0.71 ± 0.02 g/L) (P < 0.0001, in all cases). AHSG levels were comparable between the CD and UC groups. Based on AHSG levels IBD patients could be distinguished from HC with about 90% sensitivity and specificity. Further adjusted analysis verified the inverse association between AHSG and penetrating, as well as stricturing CD (partial correlation coefficient: -0.45 and -0.33, respectively) (P < 0.05). After adjusting for confounding factors, inverse correlations between AHSG and CRP and the need for anti-TNFα therapy or surgery, were found (partial correlation coefficients: -0.31, -0.33, -0.41, respectively, P < 0.05, in all cases). Finally, IBD individuals who were seropositive, for at least one marker, had AHSG levels falling within the two lower quartiles (OR = 2.86, 95%CI: 1.5-5.44, P

  15. Utility of Consumer Physical Activity Trackers as an Intervention Tool in Cardiovascular Disease Prevention and Treatment.

    PubMed

    Hickey, Amanda M; Freedson, Patty S

    2016-01-01

    Consumer activity trackers have grown in popularity over the last few years. These devices are typically worn on the hip or wrist and provide the user with information about physical activity measures such as steps taken, energy expenditure, and time spent in moderate to vigorous physical activity. The consumer may also use the computer interface (e.g. device websites, smartphone applications) to monitor and track achievement of PA goals and compete with other users. This review will describe some of the most popular consumer devices and discuss the user feedback tools. We will also present the limited evidence available about the accuracy of these devices and highlight how they have been used in cardiovascular disease management. We conclude with some recommendations for future research, focusing on how consumer devices might be used to assess effectiveness of various cardiovascular treatments.

  16. Differentiating cardiomyopathy of coronary artery disease from nonischemic dilated cardiomyopathy utilizing positron emission tomography

    SciTech Connect

    Mody, F.V.; Brunken, R.C.; Stevenson, L.W.; Nienaber, C.A.; Phelps, M.E.; Schelbert, H.R. )

    1991-02-01

    To determine if imaging of blood flow (using N-13 ammonia) and glucose metabolism (using F-18 2-deoxyglucose) with positron emission tomography can distinguish cardiomyopathy of coronary artery disease from nonischemic dilated cardiomyopathy, 21 patients with severe left ventricular dysfunction who were evaluated for cardiac transplantation were studied. The origin of left ventricular dysfunction had been previously determined by coronary angiography to be ischemic (11 patients) or nonischemic (10 patients). Images were visually analyzed by three observers on a graded scale in seven left ventricular segments and revealed fewer defects in dilated cardiomyopathy compared with ischemic cardiomyopathy for N-13 ammonia (2.7 +/- 1.6 versus 5 +/- 0.6; p less than 0.03) and F-18 deoxyglucose (2.8 +/- 2.1 versus 4.6 +/- 1.1; p less than 0.03). An index incorporating extent and severity of defects revealed more homogeneity with fewer and less severe defects in subjects with nonischemic than in those with ischemic cardiomyopathy as assessed by imaging of flow (2.8 +/- 1.8 versus 9.2 +/- 3; p less than 0.001) and metabolism (3.8 +/- 3.3 versus 8.5 +/- 3.6; p less than 0.005). Diagnostic accuracy for distinguishing the two subgroups by visual image analysis was 85%. Using previously published circumferential count profile criteria, patients with dilated cardiomyopathy had fewer ischemic segments (0.4 +/- 0.8 versus 2.5 +/- 2 per patient; p less than 0.01) and infarcted segments (0.1 +/- 0.3 versus 2.4 +/- 1.4 per patient; p less than 0.001) than did patients with cardiomyopathy of coronary artery disease. The sensitivity for differentiating the two clinical subgroups using circumferential profile analysis was 100% and the specificity 80%.

  17. Utility of Bronchoalveolar Lavage for the Diagnosis of Asbestos-Related Diseases.

    PubMed

    Cruz, María Jesús; Curull, Victor; Pijuan, Lara; Álvarez-Simón, Daniel; Sánchez-Font, Albert; de Gracia, Javier; Culebras, Mario; Ferrer, Jaume

    2017-06-01

    Bronchoalveolar lavage (BAL) analysis has been proposed as an objective technique for confirming asbestos exposure. However, the reliability and diagnostic yield of this procedure has not been studied in Spain. The aim of this study was to assess the usefulness of the analysis of asbestos bodies (AB) in bronchoalveolar lavage (BAL) for the diagnosis of asbestos-related diseases (ARD). BAL samples from 72 patients (66 male, mean age 66 years) undergoing bronchoscopy were analyzed. Lung tissue from 23 of these patients was also analyzed. Asbestos exposure was assessed by anamnesis and a review of the patient's medical records. BAL and lung samples were processed and AB count was determined by light microscopy. The accepted threshold value to diagnose asbestos-related diseases was 1 AB/ml BAL or 1000 AB/gr dry tissue. Thirty-nine patients reported exposure to asbestos. Of these, 13 (33%) presented AB values above 1 AB/ml BAL. In the 33 non-exposed patients, 5 (15%) presented AB values above 1 AB/ml BAL. There was a significant difference between the AB levels of exposed and non-exposed patients (P=.006). The ROC curve showed that a value of 0.5 AB/ml BAL achieved the most satisfactory sensitivity, 46%, and a specificity of 83%. The correlation between AB levels in BAL and lung was 0.633 (P=.002). BAL study provides objective evidence of exposure to asbestos. The good correlation between the AB counts in BAL and lung tissue indicates that both techniques are valid for the analysis of asbestos content. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Earlier surgical intervention in congenital heart disease results in better outcome and resource utilization

    PubMed Central

    2011-01-01

    Background Congenital heart disease (CHD) accounts for a major proportion of disease in the pediatric age group. The objective of the study was to estimate the cost of illness associated with CHD pre, intra and postoperatively; among patients referred to a tertiary care hospital in Karachi, Pakistan. This is the first study conducted to estimate the cost of managing CHD in Pakistan. Methods A prevalence based cost of illness study design was used to estimate the cost of cardiac surgery (corrective & palliative) for congenital heart defects in children ≤ 5 years of age from June 2006 to June 2009. A total of 120 patients were enrolled after obtaining an informed consent and the data was collected using a pre-tested questionnaire. Results The mean age at the time of surgery in group A (1-12 mo age) was 6.08 ± 2.80 months and in group B (1-5 yrs) was 37.10 ± 19.94 months. The cost of surgical admission was found to be significantly higher in the older group, p = 0.001. The total number and cost of post-operative outpatient visits was also higher in group B, p = 0.003. Pre and post operative hospital admissions were not found to be significantly different among the two groups, p = 0.166 and 0.627, respectively. The number of complications were found to be different between the two groups (p = 0.019). Majority of these were contributed by hemorrhage and post-operative seizures. Conclusion This study concluded that significant expenditure is incurred by people with CHD; with the implication that resources could be saved by earlier detection and awareness campaigns. PMID:22206493

  19. DIAGNOSIS OF ENDOCRINE DISEASE: 18-Oxocortisol and 18-Hydroxycortisol. Is there clinical utility of these steroids?

    PubMed

    Lenders, Jacques; Williams, Tracy A; Reincke, Martin; Gomez-Sanchez, Celso E

    2017-09-13

    Since the early nineteen eighties 18-hydroxycortisol and 18-oxocortisol have attracted attention when it was shown that the urinary excretion of these hybrid steroids was increased in primary aldosteronism. The development and more widespread use of specific assays has improved the understanding of their role in the (patho)physiology of adrenal disorders. The adrenal site of synthesis is not fully understood although it is clear that for the synthesis of 18-hydroxycortisol and 18-oxocortisol the action of both aldosterone synthase (zona glomerulosa) and 17α-hydroxylase (zona fasciculata) is required with cortisol as main substrate. The major physiological regulator is ACTH and the biological activity of both steroids is very low and therefore only very high concentrations might be effective in vivo. In healthy subjects the secretion of both steroids is low with 18-hydroxycortisol being substantially higher than that of 18-oxocortisol. The highest secretion of both steroids has been found in familial hyperaldosteronism type 1 (glucocorticoid-remediable aldosteronism) and in familial hyperaldosteronism type 3. Lower but yet substantially increased secretion is found in patients with aldosterone-producing adenomas in contrast to bilateral hyperplasia in whom the levels are similar to patients with hypertension. Several studies have attempted to show that these steroids, in particular peripheral venous plasma 18-oxocortisol, might be a useful discriminatory biomarker for subtyping PA patients. The current available limited evidence precludes the use of these steroids for subtyping. We review the biosynthesis, regulation and function of 18-hydroxycortisol and 18-oxocortisol and their potential utility for the diagnosis and differential diagnosis of patients with primary aldosteronism.

  20. The begomoviruses Honeysuckle yellow vein mosaic virus and Tobacco leaf curl Japan virus with DNAbeta satellites cause yellow dwarf disease of tomato.

    PubMed

    Ogawa, T; Sharma, P; Ikegami, M

    2008-11-01

    The complete nucleotide sequences of two begomoviruses (Nara virus-1 and Nara virus-2), a satellite DNA (DNAbeta-Nara) and defective DNAs were obtained from honeysuckle (Lonicera japonica) showing characteristic yellow vein mosaic symptoms in Nara Prefecture, Japan. One begomovirus (Ibaraki virus) and a satellite DNA (DNAbeta-Ibaraki) was isolated and cloned from honeysuckle plants exhibited typical yellowing of veins and small elliptical shaped enations along veins on the under side of the leaves in Ibaraki Prefecture, Japan. The genome organization of the three viruses is the same as those of other Old World monopartite begomoviruses. Nara virus-1 had overall nucleotide sequence identity with Nara virus-2 of 94% and Ibaraki virus of 90%. DNAbeta-Nara had overall nucleotide sequence identity with DNAbeta-Ibaraki of 83%. Comparison of the nucleotide sequences with other begomoviruses revealed that Nara virus-1 and Nara virus-2 are strains of Honeysuckle yellow vein mosaic virus (HYVMV), hence named as HYVMV-Nara1 and HYVMV-Nara2, whereas Ibaraki virus was a strain of Tobacco leaf curl Japan virus (TbLCJV), designated as TbLCJV-Hs[Iba]. HYVMV-Nara1 and HYVMV-Nara2 have hybrid genomes, which are likely to have formed recombination between HYVMV and TbLCJV. TbLCJV-Hs[Iba] or HYVMV-Nara2 could infect and cause yellowing, leaf crinkling and stunting symptoms when partial tandem dimeric constructs were agroinoculated on tomato plants. However, in the presence of DNAbeta, both TbLCJV-Hs[Iba] or HYVMV-Nara2 produced more severe stunting symptoms in tomato plants. Therefore, these viruses along with their satellites are causal agents of tomato yellow dwarf disease in Japan, and honeysuckle acts as a potential reservoir host. Previously available evidence indicated that DNAbeta elements do not contain iteron sequences of their helper viruses; hence this is the first evidence that DNAbeta satellites have the iteron of their helper virus.

  1. Satellite-enhanced personal communications experiments

    NASA Technical Reports Server (NTRS)

    Pinck, Deborah S.; Tong, Loretta H.; McAuley, Anthony J.; Kramer, Michael

    1995-01-01

    As an initial step in exploring the opportunities afforded by the merging of satellite and terrestrial networks, Bellcore and JPL conducted several experiments utilizing Bellcore's experimental Personal Communications System, NASA's Advanced Communications Technology Satellite (ACTS) and JPL's ACTS Mobile Terminal. These experiments provided valuable information on the applications, interfaces, and protocols needed for seamless integration of satellite and terrestrial networks.

  2. On the definition and utilization of heritable variation among hosts in reproduction ratio R0 for infectious diseases.

    PubMed

    Anche, M T; de Jong, M C M; Bijma, P

    2014-10-01

    Infectious diseases have a major role in evolution by natural selection and pose a worldwide concern in livestock. Understanding quantitative genetics of infectious diseases, therefore, is essential both for understanding the consequences of natural selection and for designing artificial selection schemes in agriculture. The basic reproduction ratio, R0, is the key parameter determining risk and severity of infectious diseases. Genetic improvement for control of infectious diseases in host populations should therefore aim at reducing R0. This requires definitions of breeding value and heritable variation for R0, and understanding of mechanisms determining response to selection. This is challenging, as R0 is an emergent trait arising from interactions among individuals in the population. Here we show how to define breeding value and heritable variation for R0 for genetically heterogeneous host populations. Furthermore, we identify mechanisms determining utilization of heritable variation for R0. Using indirect genetic effects, next-generation matrices and a SIR (Susceptible, Infected and Recovered) model, we show that an individual's breeding value for R0 is a function of its own allele frequencies for susceptibility and infectivity and of population average susceptibility and infectivity. When interacting individuals are unrelated, selection for individual disease status captures heritable variation in susceptibility only, yielding limited response in R0. With related individuals, however, there is a secondary selection process, which also captures heritable variation in infectivity and additional variation in susceptibility, yielding substantially greater response. This shows that genetic variation in susceptibility represents an indirect genetic effect. As a consequence, response in R0 increased substantially when interacting individuals were genetically related.

  3. Utility of genetic and non-genetic risk factors in predicting coronary heart disease in Singaporean Chinese.

    PubMed

    Chang, Xuling; Salim, Agus; Dorajoo, Rajkumar; Han, Yi; Khor, Chiea-Chuen; van Dam, Rob M; Yuan, Jian-Min; Koh, Woon-Puay; Liu, Jianjun; Goh, Daniel Yt; Wang, Xu; Teo, Yik-Ying; Friedlander, Yechiel; Heng, Chew-Kiat

    2017-01-01

    Background Although numerous phenotype based equations for predicting risk of 'hard' coronary heart disease are available, data on the utility of genetic information for such risk prediction is lacking in Chinese populations. Design Case-control study nested within the Singapore Chinese Health Study. Methods A total of 1306 subjects comprising 836 men (267 incident cases and 569 controls) and 470 women (128 incident cases and 342 controls) were included. A Genetic Risk Score comprising 156 single nucleotide polymorphisms that have been robustly associated with coronary heart disease or its risk factors ( p < 5 × 10(-8)) in at least two independent cohorts of genome-wide association studies was built. For each gender, three base models were used: recalibrated Adult Treatment Panel III (ATPIII) Model (M1); ATP III model fitted using Singapore Chinese Health Study data (M2) and M3: M2 + C-reactive protein + creatinine. Results The Genetic Risk Score was significantly associated with incident 'hard' coronary heart disease ( p for men: 1.70 × 10(-10)-1.73 × 10(-9); p for women: 0.001). The inclusion of the Genetic Risk Score in the prediction models improved discrimination in both genders (c-statistics: 0.706-0.722 vs. 0.663-0.695 from base models for men; 0.788-0.790 vs. 0.765-0.773 for women). In addition, the inclusion of the Genetic Risk Score also improved risk classification with a net gain of cases being reclassified to higher risk categories (men: 12.4%-16.5%; women: 10.2% (M3)), while not significantly reducing the classification accuracy in controls. Conclusions The Genetic Risk Score is an independent predictor for incident 'hard' coronary heart disease in our ethnic Chinese population. Inclusion of genetic factors into coronary heart disease prediction models could significantly improve risk prediction performance.

  4. Utilizing satellite precipitation estimates for streamflow forecasting via adjustment of mean field bias in precipitation data and assimilation of streamflow observations

    NASA Astrophysics Data System (ADS)

    Lee, Haksu; Zhang, Yu; Seo, Dong-Jun; Xie, Pingping

    2015-10-01

    This study explores mitigating bias in satellite quantitative precipitation estimates (SQPE) and improving hydrologic predictions at ungauged locations via adjustment of the mean field bias (MFB) in SQPE and data assimilation (DA) of streamflow observations in a distributed hydrologic model. In this study, a variational procedure is used to adjust MFB in Climate Prediction Center MORPHing (CMORPH) SQPE and assimilate streamflow observations at the outlet of Elk River Basin in Missouri into the distributed Sacramento Soil Moisture Accounting (SAC-SMA) and kinematic wave routing models. The benefits of assimilation are assessed by comparing the streamflow predictions with or without DA at both the outlet and an upstream location, and by comparing the soil moisture grids forced by CMORPH SQPE against those forced by higher-quality multisensor quantitative precipitation estimates (MQPE) from National Weather Service. Special attention is given to the dependence of the efficacy of DA on the quality and latency of the SQPE, and the impact of dynamic correction of MFB in the SQPE via DA. The results show that adjusting MFB in CMORPH SQPE in addition to assimilating outlet flow reduces 66% of the bias in the CMORPH SQPE analysis and the RMSE of 12-h streamflow predictions by 81% at the outlet and 34-62% at interior locations of the catchment. Compared to applying a temporally invariant MFB for the entire storm, the DA-based, dynamic MFB correction reduces the RMSE of 6-h streamflow prediction by 63% at the outlet and 39-69% at interior locations. It is also shown that the accuracy of streamflow prediction deteriorates if the delineation of the precipitation area by CMORPH SQPE is significantly different, as measured by the Hausdorff distance, from that by MQPE. When compared with adjusting MFB in the CMORPH SQPE over the entire assimilation window, adjusting the MFB for all but the latest 18 h (i.e., the latency of CMORPH SQPE) within the assimilation window reduces the

  5. The Association between Educational Attainment and Patterns of Emergency Department Utilization among Adults with Sickle Cell Disease.

    PubMed

    Jonassaint, C R; Beach, M C; Haythornthwaite, J A; Bediako, S M; Diener-West, M; Strouse, J J; Lanzkron, S; Onojobi, G; Carroll, C P; Haywood, C

    2016-06-01

    Patients with low educational attainment may be at increased risk for unplanned health care utilization. This study aimed to determine what factors are related to emergency department (ED) visits in hopes of guiding treatments and early interventions. At two medical centers in the Mid-Atlantic United States, 258 adults with sickle cell disease aged 19-70 years participated in a retrospective study where we examined whether education level is independently associated with ED visits after accounting for other socioeconomic status (SES) variables, such as pain and disease severity and psychosocial functioning. The data showed that patients without a high school education visited the ED three times as frequently as patients with post secondary education. Controlling for poverty and employment status decreased the effect of education on ED visits by 33.24 %. Further controlling for disease severity and/or psychosocial functioning could not account for the remaining association between education and ED visits, suggesting that education is independently associated with potentially avoidable emergency care. Early interventions addressing disparities in academic performance, especially for those children most at risk, may lead to improved long-term health outcomes in this population.

  6. Regulatory Forum Opinion Piece(*): Use and Utility of Animal Models of Disease for Nonclinical Safety Assessment: A Pharmaceutical Industry Survey.

    PubMed

    Morgan, Sherry J; Couch, Jessica; Guzzie-Peck, Peggy; Keller, Douglas A; Kemper, Ray; Otieno, Monicah A; Schulingkamp, Robert J; Jones, Thomas W

    2017-04-01

    An Innovation and Quality (IQ) Consortium focus group conducted a cross-company survey to evaluate current practices and perceptions around the use of animal models of disease (AMDs) in nonclinical safety assessment of molecules in clinical development. The IQ Consortium group is an organization of pharmaceutical and biotechnology companies with the mission of advancing science and technology. The survey queried the utilization of AMDs during drug discovery in which drug candidates are evaluated in efficacy models and limited short-duration non-Good Laboratory Practices (GLP) toxicology testing and during drug development in which drug candidates are evaluated in GLP toxicology studies. The survey determined that the majority of companies used AMDs during drug discovery primarily as a means for proactively assessing potential nonclinical safety issues prior to the conduct of toxicology studies, followed closely by the use of AMDs to better understand toxicities associated with exaggerated pharmacology in traditional toxicology models or to derisk issues when the target is only expressed in the disease state. In contrast, the survey results indicated that the use of AMDs in development is infrequent, being used primarily to investigate nonclinical safety issues associated with targets expressed only in disease states and/or in response to requests from global regulatory authorities.

  7. Brain uptake and utilization of fatty acids: applications to peroxisomal biogenesis diseases.

    PubMed

    Watkins, P A; Hamilton, J A; Leaf, A; Spector, A A; Moore, S A; Anderson, R E; Moser, H W; Noetzel, M J; Katz, R

    2001-01-01

    The brain is rich in diverse fatty acids saturated, monounsaturated and polyunsaturated fatty acids with chain lengths ranging from less than 16 to more than 24 carbons that make up the complex lipids present in this organ. While some fatty acids are derived from endogenous synthesis, others must come from exogenous sources. The mechanism(s) by which fatty acids enter cells has been the subject of much debate. While some investigators argue for a protein-mediated process, others suggest that simple diffusion is sufficient. In the brain, uptake is further complicated by the presence of the blood-brain barrier. Brain fatty acid homeostasis is disturbed in many human disorders, as typified by the peroxisomal biogenesis diseases. A workshop designed to bring together researchers from varied backgrounds to discuss these issues in an open forum was held in March, 2000. In addition to assessing the current state of knowledge, areas requiring additional investigation were identified and recommendations for future research were made. A brief overview of the invited talks is presented here.

  8. Clinical utility of esomeprazole for treatment of gastroesophageal reflux disease in pediatric and adolescent patients

    PubMed Central

    Cardile, Sabrina; Romano, Claudio

    2012-01-01

    Gastroesophageal reflux is a common condition in the pediatric population, with an increasing incidence in the last few years. It can be defined as an effortless retrograde movement of gastric contents into the esophagus related to complex multifactorial pathogenesis, involving anatomical, hormonal, environmental, and genetic factors. In some cases, it may be associated with esophageal or extraesophageal symptoms (heartburn and regurgitation), and is defined as gastroesophageal reflux disease (GERD). The therapeutic approach to gastroesophageal reflux in infants and children is often conservative, including changes in lifestyle (eg, posture and thickening of meals). If these children remain symptomatic after lifestyle changes (nutrition, feeding, and positional modification), or present with clinical red flags (poor weight gain, recurrent respiratory symptoms, or hematemesis) and complications of GERD (esophagitis, bleeding, stricture, Barrett’s esophagus, or adenocarcinoma) it may be necessary to set up a proper diagnostic protocol. Proton pump inhibitors have been recommended as the most effective acid suppression therapy for adults and pediatric patients. Esomeprazole, the S-isomer of omeprazole, is the only single-isomer proton pump inhibitor available. The paper assesses the safety and tolerability of esomeprazole in pediatric and adolescent patients. PMID:24600284

  9. Satellite theory

    NASA Astrophysics Data System (ADS)

    Kozai, Y.

    1981-04-01

    The dynamical characteristics of the natural satellite of Mars, Jupiter, Saturn, Uranus and Neptune are analyzed on the basis of the solar tidal perturbation factor and the oblateness factor of the primary planet for each satellite. For the inner satellites, for which the value of the solar tidal factor is much smaller than the planetary oblateness factor, it is shown that the eccentricity and inclination of satellite orbits are generally very small and almost constant; several pairs of inner satellites are also found to exhibit commensurable mean motions, or secular accelerations in mean longitude. In the case of the outer satellites, for which solar perturbations are dominant, secular perturbations and long-period perturbations may be derived by the solution of equations of motion reduced to one degree of freedom. The existence of a few satellites, termed intermediary satellites, for which the solar tidal perturbation is on the order of the planetary oblateness factor, is also observed, and the pole of the orbital plane of the satellite is noted to execute a complex motion around the pole of the planet or the orbital plane of the planet.

  10. Inertial storage for satellites

    SciTech Connect

    Eisenhaure, D.

    1984-11-01

    A new system is being developed that performs satellite attitude control, attitude reference, and energy storage utilizing inertia wheels. The baseline approach consists of two counter rotating flywheels suspended in specially designed magnetic bearings, spin axis motor/generators, and a control system. The control system regulates the magnetic bearings and spin axis motor/generators and interacts with other satellite subsystems (photovoltaic array, star trackers, Sun sensors, magnetic torquers, etc.) to perform the three functions. Existing satellites utilize separate subsystems to perform attitude control, provide attitude reference, and store energy. These functions are currently performed using reaction or momentum wheels, gyros, batteries, and devices that provide an absolute reference (Sun sensors and star trackers). A Combined Attitude, Reference, and Energy Storage (CARES) system based on high energy density inertial energy storage wheels (flywheels) has potential advantages over existing technologies. Even when used only for energy storage, this system offers the potential for substantial improvements in life, energy efficiency, and weight over existing battery technologies. Utilizing this same device for both attitude control and attitude reference would result in significant additional savings in overall satellite weight and complexity.

  11. Inertial storage for satellites

    NASA Technical Reports Server (NTRS)

    Eisenhaure, D.

    1984-01-01

    A new system is being developed that performs satellite attitude control, attitude reference, and energy storage utilizing inertia wheels. The baseline approach consists of two counter rotating flywheels suspended in specially designed magnetic bearings, spin axis motor/generators, and a control system. The control system regulates the magnetic bearings and spin axis motor/generators and interacts with other satellite subsystems (photovoltaic array, star trackers, Sun sensors, magnetic torquers, etc.) to perform the three functions. Existing satellites utilize separate subsystems to perform attitude control, provide attitude reference, and store energy. These functions are currently performed using reaction or momentum wheels, gyros, batteries, and devices that provide an absolute reference (Sun sensors and star trackers). A Combined Attitude, Reference, and Energy Storage (CARES) system based on high energy density inertial energy storage wheels (flywheels) has potential advantages over existing technologies. Even when used only for energy storage, this system offers the potential for substantial improvements in life, energy efficiency, and weight over existing battery technologies. Utilizing this same device for both attitude control and attitude reference would result in significant additional savings in overall satellite weight and complexity.

  12. Utility of SARC-F for Assessing Physical Function in Elderly Patients With Cardiovascular Disease.

    PubMed

    Tanaka, Shinya; Kamiya, Kentaro; Hamazaki, Nobuaki; Matsuzawa, Ryota; Nozaki, Kohei; Maekawa, Emi; Noda, Chiharu; Yamaoka-Tojo, Minako; Matsunaga, Atsuhiko; Masuda, Takashi; Ako, Junya

    2017-02-01

    A simple and inexpensive tool for screening of sarcopenia would be helpful for clinicians. The present study was performed to determine whether the SARC-F questionnaire is useful in screening of patients with cardiovascular disease (CVD) for impaired physical function. Cross-sectional study. Single university hospital. A total of 235 Japanese patients ≥65 years old admitted to our hospital for CVD. SARC-F, handgrip strength, leg strength, respiratory muscle strength, standing balance, usual gait speed, Short Physical Performance Battery (SPPB) score, and 6-minute walking distance were measured before discharge from hospital. The patients were divided into 2 groups according to SARC-F score: SARC-F < 4 (nonsarcopenia group) and SARC-F ≥ 4 (sarcopenia group). The sarcopenia prevalence rate was 25.5% and increased with age (P trend < .001). The sarcopenia group (SARC-F score ≥ 4) had significantly lower handgrip strength, leg strength, and respiratory muscle strength, poorer standing balance, slower usual gait speed, lower SPPB score, and shorter 6-minute walking distance compared to the nonsarcopenia group (SARC-F score < 4). Patients in the sarcopenia group had consistently poorer physical function even after adjusting for covariates. The SARC-F questionnaire is a useful screening tool for impaired physical function in elderly CVD patients. These findings support the use of the SARC-F for screening in hospital settings. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  13. The effects of synoptic weather on influenza infection incidences: a retrospective study utilizing digital disease surveillance

    NASA Astrophysics Data System (ADS)

    Zhao, Naizhuo; Cao, Guofeng; Vanos, Jennifer K.; Vecellio, Daniel J.

    2017-02-01

    The environmental drivers and mechanisms of influenza dynamics remain unclear. The recent development of influenza surveillance-particularly the emergence of digital epidemiology-provides an opportunity to further understand this puzzle as an area within applied human biometeorology. This paper investigates the short-term weather effects on human influenza activity at a synoptic scale during cold seasons. Using 10 years (2005-2014) of municipal level influenza surveillance data (an adjustment of the Google Flu Trends estimation from the Centers for Disease Control's virologic surveillance data) and daily spatial synoptic classification weather types, we explore and compare the effects of weather exposure on the influenza infection incidences in 79 cities across the USA. We find that during the cold seasons the presence of the polar [i.e., dry polar (DP) and moist polar (MP)] weather types is significantly associated with increasing influenza likelihood in 62 and 68% of the studied cities, respectively, while the presence of tropical [i.e., dry tropical (DT) and moist tropical (MT)] weather types is associated with a significantly decreasing occurrence of influenza in 56 and 43% of the cities, respectively. The MP and the DP weather types exhibit similar close positive correlations with influenza infection incidences, indicating that both cold-dry and cold-moist air provide favorable conditions for the occurrence of influenza in the cold seasons. Additionally, when tropical weather types are present, the humid (MT) and the dry (DT) weather types have similar strong impacts to inhibit the occurrence of influenza. These findings suggest that temperature is a more dominating atmospheric factor than moisture that impacts the occurrences of influenza in cold seasons.

  14. The University of NSW electronic practice based research network: disease registers, data quality and utility.

    PubMed

    Taggart, J; Liaw, S T; Dennis, S; Yu, H; Rahimi, A; Jalaludin, B; Harris, M

    2012-01-01

    Accurate well-maintained registers are a prerequisite to co-ordinated care of patients with chronic diseases. Their effectiveness in enabling improved management is dependent on the quality of the information captured. This paper provides an overview into the methodology and data quality of the electronic Practice Based Research Network. Clinical records with no identifying information are routinely extracted from four general practices. The data are linked in the data warehouse. Data quality is assessed for completeness, correctness and consistency. Reports on data quality are given back to practices and semi-structured interviews provide information to interpret the results and discuss how data quality could be improved. Data quality is mostly complete for sex and date of birth but indigenous status, smoking and weight were incomplete. There are generally high levels of correctness and internal consistency. Completeness of records in assisting the management of diabetes patients using the annual cycle of care was poor. GPs often use the progress notes to enter information during the consultation and coding diagnoses was considered onerous. The routine capture of electronic clinical health records from primary health care and health services can be used to monitor performance and improve the quality of clinical records. There is a need for accurate and comprehensive clinical records to ensure the safety and quality of clinical practice. Understanding the true reasons for poor data quality is complex. Having a community-based research network may assist in answering some of these questions. Electronic health records are increasingly being used for secondary research and evaluation, beyond the primary purpose of supporting clinical care. The data must be of sufficient quality to support these purposes.

  15. The effects of synoptic weather on influenza infection incidences: a retrospective study utilizing digital disease surveillance.

    PubMed

    Zhao, Naizhuo; Cao, Guofeng; Vanos, Jennifer K; Vecellio, Daniel J

    2017-02-11

    The environmental drivers and mechanisms of influenza dynamics remain unclear. The recent development of influenza surveillance--particularly the emergence of digital epidemiology--provides an opportunity to further understand this puzzle as an area within applied human biometeorology. This paper investigates the short-term weather effects on human influenza activity at a synoptic scale during cold seasons. Using 10 years (2005-2014) of municipal level influenza surveillance data (an adjustment of the Google Flu Trends estimation from the Centers for Disease Control's virologic surveillance data) and daily spatial synoptic classification weather types, we explore and compare the effects of weather exposure on the influenza infection incidences in 79 cities across the USA. We find that during the cold seasons the presence of the polar [i.e., dry polar (DP) and moist polar (MP)] weather types is significantly associated with increasing influenza likelihood in 62 and 68% of the studied cities, respectively, while the presence of tropical [i.e., dry tropical (DT) and moist tropical (MT)] weather types is associated with a significantly decreasing occurrence of influenza in 56 and 43% of the cities, respectively. The MP and the DP weather types exhibit similar close positive correlations with influenza infection incidences, indicating that both cold-dry and cold-moist air provide favorable conditions for the occurrence of influenza in the cold seasons. Additionally, when tropical weather types are present, the humid (MT) and the dry (DT) weather types have similar strong impacts to inhibit the occurrence of influenza. These findings suggest that temperature is a more dominating atmospheric factor than moisture that impacts the occurrences of influenza in cold seasons.

  16. AβPP-overexpressing transgenic rat model of Alzheimer's disease utilizing the Tg2576 mouse protocol.

    PubMed

    O'Hare, Eugene; Ardis, Tara; Page, Deaglan; Scopes, David I C; Kim, Eun-Mee

    2013-01-01

    The current study examined behavioral and histological effects of amyloid-β (Aβ) protein precursor (AβPP) overexpression in transgenic (Tg) rats created using the same gene, mutation, and promoter as the Tg2576 mouse model of Alzheimer's disease (AD). Male Tg+ rats were bred with female wild-type rats to generate litters of hemizygous Tg+ and Tg- offspring. Tg+ rats and Tg- littermates were tested for memory deficits at 4, 8, and 12 months old using a water-maze procedure. There were no significant behavioral differences between Tg+ rats and Tg- littermates at 4 months old but there were significant differences at 8 and 12 months old, and in probe trials at 8 and 12 months old, the Tg+ rats spent significantly less time and covered less distance in the platform zone. Under acquisition of a fixed-consecutive number schedule at 3 months old, Tg- littermates demonstrated a longer latency to learning the response rule than Tg+ rats; while this might seem paradoxical, it is consistent with the role of overexpression of AβPP in learning. Histological analyses revealed activated astrocytes in brains of Tg+ rats but not Tg- littermates at 6 months old, and thioflavin-S positive staining in the hippocampus and cortex of 17-month old Tg+ rats but not Tg- littermates. Quantification of Aβ load in the brain at 22 months indicated high levels of Aβ38, Aβ40, and Aβ42 in the Tg+ rats. These data suggest this model might provide a valuable resource for AD research.

  17. Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging

    PubMed Central

    Santana, Pauliane Vieira; Prina, Elena; Albuquerque, André Luis Pereira; Carvalho, Carlos Roberto Ribeiro; Caruso, Pedro

    2016-01-01

    Objective: To investigate the applicability of ultrasound imaging of the diaphragm in interstitial lung disease (ILD). Methods: Using ultrasound, we compared ILD patients and healthy volunteers (controls) in terms of diaphragmatic mobility during quiet and deep breathing; diaphragm thickness at functional residual capacity (FRC) and at total lung capacity (TLC); and the thickening fraction (TF, proportional diaphragm thickening from FRC to TLC). We also evaluated correlations between diaphragmatic dysfunction and lung function variables. Results: Between the ILD patients (n = 40) and the controls (n = 16), mean diaphragmatic mobility was comparable during quiet breathing, although it was significantly lower in the patients during deep breathing (4.5 ± 1.7 cm vs. 7.6 ± 1.4 cm; p < 0.01). The patients showed greater diaphragm thickness at FRC (p = 0.05), although, due to lower diaphragm thickness at TLC, they also showed a lower TF (p < 0.01). The FVC as a percentage of the predicted value (FVC%) correlated with diaphragmatic mobility (r = 0.73; p < 0.01), and an FVC% cut-off value of < 60% presented high sensitivity (92%) and specificity (81%) for indentifying decreased diaphragmatic mobility. Conclusions: Using ultrasound, we were able to show that diaphragmatic mobility and the TF were lower in ILD patients than in healthy controls, despite the greater diaphragm thickness at FRC in the former. Diaphragmatic mobility correlated with ILD functional severity, and an FVC% cut-off value of < 60% was found to be highly accurate for indentifying diaphragmatic dysfunction on ultrasound. PMID:27167428

  18. The G-765C promoter polymorphism in cyclooxygenase-2 (PTGS2), aspirin utilization and cardiovascular disease risk: the Atherosclerosis Risk in Communities (ARIC) study

    USDA-ARS?s Scientific Manuscript database

    Cyclooxygenase-2 derived prostaglandins modulate cardiovascular disease risk. We sought to determine if the reduced function G-765C promoter polymorphism in PTGS2 was associated with incident coronary heart disease (CHD) or ischemic stroke risk, and if this was modified by aspirin utilization. Usin...

  19. Epoetin zeta in the management of anemia associated with chronic kidney disease, differential pharmacology and clinical utility

    PubMed Central

    Davis-Ajami, Mary Lynn; Wu, Jun; Downton, Katherine; Ludeman, Emilie; Noxon, Virginia

    2014-01-01

    Epoetin zeta was granted marketing authorization in October 2007 by the European Medicines Agency as a recombinant human erythropoietin erythropoiesis-stimulating agent to treat symptomatic anemia of renal origin in adult and pediatric patients on hemodialysis and adults on peritoneal dialysis, as well as for symptomatic renal anemia in adult patients with renal insufficiency not yet on dialysis. Currently, epoetin zeta can be administered either subcutaneously or intravenously to correct for hemoglobin concentrations ≤10 g/dL (6.2 mmol/L) or with dose adjustment to maintain hemoglobin levels at desired levels not in excess of 12 g/dL (7.5 mmol/L). This review article focuses on epoetin zeta indications in chronic kidney disease, its use in managing anemia of renal origin, and discusses its pharmacology and clinical utility. PMID:24790409

  20. Clinical utilization of anti-VEGF agents and disease monitoring in neovascular age-related macular degeneration.

    PubMed

    Holekamp, Nancy M; Liu, Ying; Yeh, Wei-Shi; Chia, Yifeng; Kiss, Szilárd; Almony, Arghavan; Kowalski, Jonathan W

    2014-04-01

    To examine bevacizumab and ranibizumab utilization and disease monitoring patterns in patients with neovascular age-related macular degeneration (neovascular AMD) in clinical practice. Retrospective medical claims analysis. Patients receiving ≥1 ranibizumab or bevacizumab injection during the 12 months after initial neovascular AMD diagnosis were included. Annual bevacizumab and/or ranibizumab injection utilization was assessed by year of first injection cohorts: 2006 and 2007 (received either agent because of billing code overlap), 2008, 2009, and January-June 2010 (received each agent). Outcome measures were time to first injection relative to neovascular AMD diagnosis and mean numbers of intravitreal injections, ophthalmologist visits, and optical coherence tomography (OCT) and fluorescein angiography (FA) examinations in 12 months. In the 2006 and 2007 cohorts (n = 8767), mean annual numbers of bevacizumab or ranibizumab injections were 4.7 and 5.0, respectively. Over 92% of patients in all cohorts received first treatment within 3 months of neovascular AMD diagnosis. In the 2008-2010 cohorts (n = 10 259), mean annual number of injections remained low (bevacizumab: 4.6, 5.1, and 5.5; ranibizumab: 6.1, 6.6, and 6.9), as did mean numbers of ophthalmologist visits (bevacizumab only) and OCT examinations (both agents), but there was no such trend in FA examinations. Compared with treatment paradigms validated by clinical trials published at the time, in clinical practice, patients with neovascular AMD received fewer bevacizumab or ranibizumab injections and less-frequent monitoring from 2006 to mid-2011. Factors contributing to this lower injection frequency and visual outcomes associated with reduced utilization need to be researched. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Factors Associated With Resource Utilization and Coronary Artery Dilation in Refractory Kawasaki Disease (from the Pediatric Health Information System Database).

    PubMed

    Lo, Jennifer Y; Minich, L LuAnn; Tani, Lloyd Y; Wilkes, Jacob; Ding, Qian; Menon, Shaji C

    2016-12-01

    Management guidelines for refractory Kawasaki disease (KD) are vague. We sought to assess practice variation and identify factors associated with large/complex coronary artery aneurysms (LCAA) and resource utilization in refractory KD. This retrospective cohort study identified patients aged ≤18 years with KD (2004 to 2014) using the Pediatric Health Information System. Refractory KD was defined as receiving >1 dose of intravenous immunoglobulin. Demographics, medications, concomitant infections, length of stay (LOS), and charges were collected. Antithrombotic therapy was a surrogate for LCAA. LOS and hospital charges assessed resource utilization. Multivariate regression identified factors associated with LOS, charges, and LCAA. Of 14,194 patients with KD, 2,974 (21%) had refractory KD and 203 of those 2,974 (7%) had LCAA. Additional intravenous immunoglobulin was the sole medication in 77%. Other medications added were steroids (18%), infliximab (2%), and both (3%). Warfarin, low-molecular-weight heparin, tissue plasminogen activator, and clopidogrel were prescribed with equal frequency (2%). Male gender (adjusted relative risk 1.52, 95% confidence interval [CI] 1.08 to 2.16, p <0.01), admission to an intensive care unit (4.79, 95% CI 3.40 to 6.74, p <0.001), arrhythmia (3.00, 95% CI 1.94 to 4.65, p <0.001), and concomitant viral infection (2.29, 95% CI 1.49 to 3.52, p <0.001) were associated with LCAA. Severe illness, race, region, and payer were independently associated with increased charges (p <0.05 for all). In conclusion, treatment for refractory KD varies widely. Concomitant viral infection was associated with a greater risk of LCAA in refractory KD. Better understanding of optimal management may improve outcomes and decrease both variability in management and resource utilization for refractory KD. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Effects of the West Africa Ebola Virus Disease on Health-Care Utilization – A Systematic Review

    PubMed Central

    Brolin Ribacke, Kim J.; Saulnier, Dell D.; Eriksson, Anneli; von Schreeb, Johan

    2016-01-01

    Significant efforts were invested in halting the recent Ebola virus disease outbreak in West Africa. Now, studies are emerging on the magnitude of the indirect health effects of the outbreak in the affected countries, and the aim of this study is to systematically assess the results of these publications. The methodology for this review adhered to the Prisma guidelines for systematic reviews. A total of 3354 articles were identified for screening, and while 117 articles were read in full, 22 studies were included in the final review. Utilization of maternal health services decreased during the outbreak. The number of cesarean sections and facility-based deliveries declined and followed a similar pattern in Guinea, Liberia, and Sierra Leone. A change in the utilization of antenatal and postnatal care and family planning services was also seen, as well as a drop in utilization of children’s health services, especially in terms of vaccination coverage. In addition, the uptake of HIV/AIDS and malaria services, general hospital admissions, and major surgeries decreased as well. Interestingly, it was the uptake of health service provision by the population that decreased, rather than the volume of health service provision. Estimates from the various studies suggest that non-Ebola morbidity and mortality have increased after the onset of the outbreak in Sierra Leone, Guinea, and Liberia. Reproductive, maternal, and child health services were especially affected, and the decrease in facility deliveries, cesarean sections, and volume of antenatal and postnatal care visits might have significant adverse effects on maternal and newborn health. The impact of Ebola stretches far beyond Ebola cases and deaths. This review indicates that indirect health service effects are substantial and both short and long term, and highlights the importance of support to maintain routine health service delivery and the maintenance of vaccination programs as well as preventative and curative

  3. Molecular diversity of Cotton leaf curl Gezira virus isolates and their satellite DNAs associated with okra leaf curl disease in Burkina Faso

    PubMed Central

    2010-01-01

    Okra leaf curl disease (OLCD) is a major constraint on okra (Abelmoschus esculentus) production and is widespread in Africa. Using a large number of samples representative of the major growing regions in Burkina Faso (BF), we show that the disease is associated with a monopartite begomovirus and satellite DNA complexes. Twenty-three complete genomic sequences of Cotton leaf curl Gezira virus (CLCuGV) isolates associated with OLCD, sharing 95 to 99% nucleotide identity, were cloned and sequenced. Six betasatellite and four alphasatellite (DNA-1) molecules were also characterized. The six isolates of betasatellite associated with CLCuGV isolates correspond to Cotton leaf curl Gezira betasatellite (CLCuGB) (88 to 98% nucleotide identity). One isolate of alphasatellite is a variant of Cotton leaf curl Gezira alphasatellite (CLCuGA) (89% nucleotide identity), whereas the three others isolates appear to correspond to a new species of alphasatellite (CLCuGA most similar sequence present 52 to 60% nucleotide identity), provisionally named Okra leaf curl Burkina Faso alphasatellite (OLCBFA). Recombination analysis of the viruses demonstrated the interspecies recombinant origin of all CLCuGV isolates, with parents being close to Hollyhock leaf crumple virus (AY036009) and Tomato leaf curl Diana virus (AM701765). Combined with the presence of satellites DNA, these results highlight the complexity of begomoviruses associated with OLCD. PMID:20178575

  4. Safety and Utility of Quantitative Sensory Testing among Adults with Sickle Cell Disease: Indicators of Neuropathic Pain?

    PubMed Central

    Ezenwa, Miriam O.; Molokie, Robert E.; Wang, Zaijie Jim; Yao, Yingwei; Suarez, Marie L.; Pullum, Cherese; Schlaeger, Judith M.; Fillingim, Roger B.; Wilkie, Diana J.

    2014-01-01

    Objectives Pain is the hallmark symptom of sickle cell disease (SCD), yet the types of pain that these patients experience, and the underlying mechanisms, have not been well characterized. The study purpose was to determine the safety and utility of a mechanical and thermal quantitative sensory testing (QST) protocol and the feasibility of utilizing neuropathic pain questionnaires among adults with SCD. Methods A convenience sample (N=25, 18 women, mean age 38.5 ± 12.5 [20–58 years]) completed self-report pain and quality-of-life tools. Subjects also underwent testing with the TSA-II NeuroSensory Analyzer and calibrated von Frey microfilaments. Results We found that the QST protocol was safe and did not stimulate a SCD pain crisis. There was evidence of central sensitization (n=15), peripheral sensitization (n=1), a mix of central and peripheral sensitization (n=8), or no sensitization (n=1). The neuropathic pain self-report tools were feasible with evidence of construct validity; 40% of the subjects reported S-LANSS scores that were indicative of neuropathic pain and had evidence of central, peripheral or mixed sensitization. Discussion The QST protocol can be safely conducted in adults with SCD and provides evidence of central or peripheral sensitization, which is consistent with a neuropathic component to SCD pain. These findings are novel, warrant a larger confirmatory study, and indicate the need for normative QST data from African American adults and older adults. PMID:25581383

  5. Update on the pathological processes, molecular biology, and clinical utility of N-acetylcysteine in chronic obstructive pulmonary disease

    PubMed Central

    Tse, Hoi Nam; Tseng, Cee Zhung Steven

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a common and morbid disease characterized by high oxidative stress. Its pathogenesis is complex, and involves excessive oxidative stress (redox imbalance), protease/antiprotease imbalance, inflammation, apoptosis, and autoimmunity. Among these, oxidative stress has a pivotal role in the pathogenesis of COPD by initiating and mediating various redox-sensitive signal transduction pathways and gene expression. The protective physiological mechanisms of the redox balance in the human body, their role in the pathogenesis of COPD, and the clinical correlation between oxidative stress and COPD are reviewed in this paper. N-acetylcysteine (NAC) is a mucolytic agent with both antioxidant and anti-inflammatory properties. This paper also reviews the use of NAC in patients with COPD, especially the dose-dependent properties of NAC, eg, its effects on lung function and the exacerbation rate in patients with the disease. Earlier data from BRONCUS (the Bronchitis Randomized on NAC Cost-Utility Study) did not suggest that NAC was beneficial in patients with COPD, only indicating that it reduced exacerbation in an “inhaled steroid-naïve” subgroup. With regard to the dose-dependent properties of NAC, two recent randomized controlled Chinese trials suggested that high-dose NAC (1,200 mg daily) can reduce exacerbations in patients with COPD, especially in those with an earlier (moderately severe) stage of disease, and also in those who are at high risk of exacerbations. However, there was no significant effect on symptoms or quality of life in patients receiving NAC. Further studies are warranted to investigate the effect of NAC at higher doses in non-Chinese patients with COPD. PMID:25125976

  6. Update on the pathological processes, molecular biology, and clinical utility of N-acetylcysteine in chronic obstructive pulmonary disease.

    PubMed

    Tse, Hoi Nam; Tseng, Cee Zhung Steven

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a common and morbid disease characterized by high oxidative stress. Its pathogenesis is complex, and involves excessive oxidative stress (redox imbalance), protease/antiprotease imbalance, inflammation, apoptosis, and autoimmunity. Among these, oxidative stress has a pivotal role in the pathogenesis of COPD by initiating and mediating various redox-sensitive signal transduction pathways and gene expression. The protective physiological mechanisms of the redox balance in the human body, their role in the pathogenesis of COPD, and the clinical correlation between oxidative stress and COPD are reviewed in this paper. N-acetylcysteine (NAC) is a mucolytic agent with both antioxidant and anti-inflammatory properties. This paper also reviews the use of NAC in patients with COPD, especially the dose-dependent properties of NAC, eg, its effects on lung function and the exacerbation rate in patients with the disease. Earlier data from BRONCUS (the Bronchitis Randomized on NAC Cost-Utility Study) did not suggest that NAC was beneficial in patients with COPD, only indicating that it reduced exacerbation in an "inhaled steroid-naïve" subgroup. With regard to the dose-dependent properties of NAC, two recent randomized controlled Chinese trials suggested that high-dose NAC (1,200 mg daily) can reduce exacerbations in patients with COPD, especially in those with an earlier (moderately severe) stage of disease, and also in those who are at high risk of exacerbations. However, there was no significant effect on symptoms or quality of life in patients receiving NAC. Further studies are warranted to investigate the effect of NAC at higher doses in non-Chinese patients with COPD.

  7. Towards an integrated understanding of the therapeutic utility of exclusive enteral nutrition in the treatment of Crohn's disease.

    PubMed

    Cuív, Páraic Ó; Begun, Jakob; Keely, Simon; Lewindon, Peter J; Morrison, Mark

    2016-04-01

    Crohn's disease (CD) is a chronic disease characterized by episodic and disabling inflammation of the gastrointestinal tract in genetically susceptible individuals. The incidence and prevalence of CD is rising rapidly across the world emphasising that disease risk is also influenced by environmental and lifestyle factors, as well as the microbial community resident in the gut. Childhood-onset CD is associated with an aggressive disease course that can adversely impact patient growth and development. There is no cure for CD however new onset and recurrent cases of paediatric CD are often responsive to exclusive enteral nutrition (EEN) treatment. EEN treatment involves the exclusive consumption of an elemental or polymeric formula for several weeks and it is well established as a primary intervention strategy. EEN treatments typically achieve remission rates of over 80% and importantly they are associated with a high rate of mucosal healing, far superior to steroids, which is prognostic of improved long-term health outcomes. Furthermore, they are safe, have few side effects, and improve nutritional status and linear growth. Surprisingly, despite the utility of EEN our understanding of the host-microbe-diet interactions that underpin clinical remission and mucosal healing are limited. Here, we review the current state of knowledge and propose that the induction of autophagy, in addition to modulation of the microbiota and coordinated effects on inflammation and epithelial cell biology, may be critical for the therapeutic effects associated with EEN. A better understanding of EEN treatment will provide new opportunities to restore gut homeostasis and prolong periods of remission, as well as provide new insights into the factors that trigger and perhaps prevent CD.

  8. Cost-utility analysis comparing radioactive iodine, anti-thyroid drugs and total thyroidectomy for primary treatment of Graves' disease.

    PubMed

    Donovan, Peter J; McLeod, Donald S A; Little, Richard; Gordon, Louisa

    2016-12-01

    Little data is in existence about the most cost-effective primary treatment for Graves' disease. We performed a cost-utility analysis comparing radioactive iodine (RAI), anti-thyroid drugs (ATD) and total thyroidectomy (TT) as first-line therapy for Graves' disease in England and Australia. We used a Markov model to compare lifetime costs and benefits (quality-adjusted life-years (QALYs)). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD). RAI was the least expensive therapy in both England (£5425; QALYs 34.73) and Australia (AUD5601; 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16 866; 35.17 QALYs; incremental cost-effectiveness ratio (ICER) £26 279 per QALY gained England; AUD8924; 31.37 QALYs; ICER AUD9687 per QALY gained Australia), while RAI dominated TT (£7115; QALYs 33.93 England; AUD15 668; 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality-of-life (HRQoL) weights; however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD. In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves' disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves' disease could improve the quality of future studies. © 2016 European Society of Endocrinology.

  9. Utilization of a free fitness center-based exercise referral program among women with chronic disease risk factors.

    PubMed

    Waterman, Megan R; Wiecha, John M; Manne, Jennifer; Tringale, Stephen M; Costa, Elizabeth; Wiecha, Jean L

    2014-12-01

    Physical activity (PA) reduces the risk for a number of chronic diseases including heart disease, hypertension, hyperlipidemia, and diabetes mellitus type 2. However, most Americans do not meet expert recommendations for exercise, and minorities and low-income persons are the most inactive. Community-based approaches to promoting PA include primary care exercise referral programs. This study examines patient characteristics associated with utilization of a community health center-based exercise referral program. Adult female patients of a community health center with an affiliated fitness center, in Boston, MA, were included in the study if they received a referral to the fitness center from their primary care provider. Demographic and medical information was abstracted from the medical chart, and fitness records were abstracted to measure activation of a fitness center membership (creation of an account denoting at least an initial visit) and utilization over time. Overall, 503 (40%) of the 1,254 referred women in the study sample activated their membership. Black women were almost 60% more likely to activate their membership (adjusted OR 1.6, 95% CI 1.2-2.2), and women with higher co-morbidity counts were almost 45% more likely to activate (adjusted OR 1.4, 95% CI 1.0-2.0). Once activated, a minority of women participated at levels likely to improve cardiometabolic fitness. Of the 503 activations, 96 (19%) had no participation, 359 (71%) had low participation, and only 48 (10%) had high participation. No independent predictors of participation were identified. These findings suggest that program design may benefit from developing activation, initial participation, and retention strategies that address population-specific barriers.

  10. Utilizing glycogen synthase kinase-3β as a marker for the diagnosis of graft-versus-host disease.

    PubMed

    Orbach, A; Bassan-Levin, T; Dan, P; Hihinashvilli, B; Marx, S

    2013-06-01

    Graft-versus-host disease (GVHD) is a deadly complication of allogeneic hematopoietic stem cell transplantation. Timely diagnosis is critical, because mortality rates for GVHD are high, increasing with disease severity. A diagnostic tool to predict GVHD before the onset of clinical symptoms could save many lives. On the cellular level, GVHD occurs when T cells from the transplant attack the tissues of the host, after perceiving them to be foreign. T-cell proliferation occurs even before clinical symptoms appear. Glycogen synthase kinase (GSK)-3β is a protein which regulates proliferation in many cell types including T-cells. GSK-3β has never been directly connected with GVHD and we applied GSK-3β as a novel marker for GVHD prediction, seeking herein to determine whether GSK-3β can be utilized as a marker for the early diagnosis of GVHD. For the mouse model of acute GVHD, irradiated mice underwent allogeneic splenocyte transplantation and GSK-3β expression levels and phosphorylation states were monitored in harvested spleens by western blot. FACS analysis was used to measure the number of T cells within the harvested spleens. Mice developed observable GVHD symptoms by day 5 post-transplantation, with severe symptoms on day 6 requiring mice to be killed for humane reasons. A significantly increased number of T cells in the allogeneic mice correlated with GVHD development. GSK-3β protein expression levels and phosphorylation levels were significantly lower in allogeneic (GVHD) mice compared with negative (untreated) and positive (syngeneic transplant; non-GVHD) controls over time. GSK-3β was directly connected with the onset and progression of GVHD. Therefore, it can be utilized as a marker for GVHD diagnosis in animals and potentially in humans. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Utility of Induced Pluripotent Stem Cells for the Study and Treatment of Genetic Diseases: Focus on Childhood Neurological Disorders

    PubMed Central

    Barral, Serena; Kurian, Manju A.

    2016-01-01

    The study of neurological disorders often presents with significant challenges due to the inaccessibility of human neuronal cells for further investigation. Advances in cellular reprogramming techniques, have however provided a new source of human cells for laboratory-based research. Patient-derived induced pluripotent stem cells (iPSCs) can now be robustly differentiated into specific neural subtypes, including dopaminergic, inhibitory GABAergic, motorneurons and cortical neurons. These neurons can then be utilized for in vitro studies to elucidate molecular causes underpinning neurological disease. Although human iPSC-derived neuronal models are increasingly regarded as a useful tool in cell biology, there are a number of limitations, including the relatively early, fetal stage of differentiated cells and the mainly two dimensional, simple nature of the in vitro system. Furthermore, clonal variation is a well-described phenomenon in iPSC lines. In order to account for this, robust baseline data from multiple control lines is necessary to determine whether a particular gene defect leads to a specific cellular phenotype. Over the last few years patient-derived neural cells have proven very useful in addressing several mechanistic questions related to central nervous system diseases, including early-onset neurological disorders of childhood. Many studies report the clinical utility of human-derived neural cells for testing known drugs with repurposing potential, novel compounds and gene therapies, which then can be translated to clinical reality. iPSCs derived neural cells, therefore provide great promise and potential to gain insight into, and treat early-onset neurological disorders. PMID:27656126

  12. Potential utility of three-dimensional temperature and salinity fields estimated from satellite altimetry and Argo data for improving mesoscale reproducibility in regional ocean modeling

    NASA Astrophysics Data System (ADS)

    Kanki, R.; Uchiyama, Y.; Miyazaki, D.; Takano, A.; Miyazawa, Y.; Yamazaki, H.

    2014-12-01

    Mesoscale oceanic structure and variability are required to be reproduced as accurately as possible in realistic regional ocean modeling. Uchiyama et al. (2012) demonstrated with a submesoscale eddy-resolving JCOPE2-ROMS downscaling oceanic modeling system that the mesoscale reproducibility of the Kuroshio meandering along Japan is significantly improved by introducing a simple restoration to data which we call "TS nudging" (a.k.a. robust diagnosis) where the prognostic temperature and salinity fields are weakly nudged four-dimensionally towards the assimilative JCOPE2 reanalysis (Miyazawa et al., 2009). However, there is not always a reliable reanalysis for oceanic downscaling in an arbitrary region and at an arbitrary time, and therefore alternative dataset should be prepared. Takano et al. (2009) proposed an empirical method to estimate mesoscale 3-D thermal structure from the near real-time AVISO altimetry data along with the ARGO float data based on the two-layer model of Goni et al. (1996). In the present study, we consider the TS data derived from this method as a candidate. We thus conduct a synoptic forward modeling of the Kuroshio using the JCOPE2-ROMS downscaling system to explore potential utility of this empirical TS dataset (hereinafter TUM-TS) by carrying out two runs with the T-S nudging towards 1) the JCOPE2-TS and 2) TUM-TS fields. An example of the comparison between the two ROMS test runs is shown in the attached figure showing the annually averaged surface EKE. Both of TUM-TS and JCOPE2-TS are found to help reproducing the mesoscale variance of the Koroshio and its extension as well as its mean paths, surface KE and EKE reasonably well. Therefore, the AVISO-ARGO derived empirical 3-D TS estimation is potentially exploitable for the dataset to conduct the T-S nudging to reproduce mesoscale oceanic structure.

  13. Calibration and Evaluation of a Flood Forecasting System: Utility of Numerical Weather Prediction Model, Data Assimilation and Satellite-based Rainfall

    NASA Astrophysics Data System (ADS)

    Yucel, Ismail; Onen, Alper; Yilmaz, Koray; Gochis, David

    2015-04-01

    A fully-distributed, multi-physics, multi-scale hydrologic and hydraulic modeling system, WRF-Hydro, is used to assess the potential for skillful flood forecasting based on precipitation inputs derived from the Weather Research and Forecasting (WRF) model and the EUMETSAT Multi-sensor Precipitation Estimates (MPEs). Similar to past studies it was found that WRF model precipitation forecast errors related to model initial conditions are reduced when the three dimensional atmospheric data assimilation (3DVAR) scheme in the WRF model simulations is used. The study then undertook a comparative evaluation of the impact of MPE versus WRF precipitation estimates, both with and without data assimilation, in driving WRF-Hydro simulated streamflow. Several flood events that occurred in the Black Sea region were used for testing and evaluation. Following model calibration, the WRF-Hydro system was capable of skillfully reproducing observed flood hydrographs in terms of the volume of the runoff produced and the overall shape of the hydrograph. Streamflow simulation skill was significantly improved for those WRF model simulations where storm precipitation was accurately depicted with respect to timing, location and amount. Accurate streamflow simulations were more evident in WRF model simulations where the 3DVAR scheme was used compared to when it was not used. Because of substantial dry bias feature of MPE, streamflow derived using this precipitation product is in general very poor. Overall, root mean squared errors for runoff were reduced by 22.2% when hydrological model calibration is performed with WRF precipitation. Errors were reduced by 36.9% (above uncalibrated model performance) when both WRF model data assimilation and hydrological model calibration was utilized. Our results also indicated that when assimilated precipitation and model calibration is performed jointly, the calibrated parameters at the gauged sites could be transferred to ungauged neighboring basins

  14. Communication satellite system beyond the year 2000

    NASA Astrophysics Data System (ADS)

    Robertson, G. J.; Fourquet, J. M.

    1991-10-01

    The primary evolutionary factors of satellite communications technologies are reviewed based on the results of a study of novel satellite developments. A critical evaluation of the viability and availability of the technologies is utilized in conjunction with market forecasts to determine promising commercial strategies. Modern technologies are almost prepared for the development of a class of communications satellites and include bandwidth utilization, spacecraft bus modularity, and functional integration.

  15. Satellite Broadcasting.

    ERIC Educational Resources Information Center

    Chayes, Abram; And Others

    This report of the 1970 International Broadcast Institute (IBI) surveyed legal and communicational experts in France, Japan, the United Kingdom, and the United States on the general topic of satellite broadcasting. The responses covered technical data (satellite and ground systems), legal information (international law and the International…

  16. Satellite Vulnerabilities

    DTIC Science & Technology

    2008-02-18

    per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and...allies. 8  Satellites and Intelligence , Surveillance, and Reconnaissance We have become dependent also on our satellite surveillance assets...uninterrupted ISR”, with “space intelligence , surveillance, and reconnaissance (ISR) systems…fundamental to air power—especially to the execution

  17. Non communicable disease multimorbidity and associated health care utilization and expenditures in India: cross-sectional study.

    PubMed

    Pati, Sanghamitra; Agrawal, Sutapa; Swain, Subhashisa; Lee, John Tayu; Vellakkal, Sukumar; Hussain, Mohammad Akhtar; Millett, Christopher

    2014-10-02

    Non communicable disease (NCD) multimorbidity is increasingly becoming common in high income settings but little is known about its epidemiology and associated impacts on citizens and health systems in low and middle-income countries (LMICs). We aim to examine the socio-demographic distribution of NCD multimorbidity (≥2 diseases) and its implications for health care utilization and out-of-pocket expenditure (OOPE) in India. We analyzed cross-sectional nationally representative data from the World Health Organisaion Study on Global Ageing and Adult Health (WHO-SAGE), conducted in India during 2007. Multiple logistic regression was used to determine socio-demographic predictors of self-reported multimorbidity. A two part model was used to assess the relationship between number of NCDs and health care utilization including OOPE. 28.5% of the sample population had at least one NCD and 8.9% had NCD multimorbidity. The prevalence of multimorbidity increased from 1.3% in 18-29 year olds to 30.6% in those aged 70 years and above. Mean outpatient visits in the preceding 12 months increased from 2.2 to 6.2 and the percentage reporting an overnight hospital stay in the past 3 years increased from 9% to 29% in those with no NCD and ≥2 NCDs respectively (p <0.001).OOPE incurred during the last outpatient visit increased from INR 272.1 (95% CI = 249.0-295.2) in respondents with no NCDs to INR 454.1 (95% CI = 407.8-500.4) in respondents with ≥2 NCDs. However, we did not find an increase in OOPE during the last inpatient visit with number of NCDs (7865.9 INR for those with zero NCDs compared with 7301.3 for those with ≥2 NCDs). For both outpatient and inpatient OOPE, medicine constitutes the largest proportion of spending (70.7% for outpatient, 53.6% for inpatient visit), followed by spending for health care provider (14.0% for outpatient, 12.2% for inpatient visit). NCD multimorbidity is common in the Indian adult population and is associated with substantially

  18. Meteorological satellites

    NASA Technical Reports Server (NTRS)

    Allison, L. J. (Editor); Schnapf, A.; Diesen, B. C., III; Martin, P. S.; Schwalb, A.; Bandeen, W. R.

    1980-01-01

    An overview is presented of the meteorological satellite programs that have been evolving from 1958 to the present, and plans for the future meteorological and environmental satellite systems that are scheduled to be placed into service in the early 1980's are reviewed. The development of the TIROS family of weather satellites, including TIROS, ESSA, ITOS/NOAA, and the present TIROS-N (the third generation operational system) is summarized. The contribution of the Nimbus and ATS technology satellites to the development of the operational-orbiting and geostationary satellites is discussed. Included are descriptions of both the TIROS-N and the DMSP payloads currently under development to assure a continued and orderly growth of these systems into the 1980's.

  19. The effect of an active implementation of a disease management programme for chronic obstructive pulmonary disease on healthcare utilization--a cluster-randomised controlled trial.

    PubMed

    Smidth, Margrethe; Christensen, Morten Bondo; Fenger-Grøn, Morten; Olesen, Frede; Vedsted, Peter

    2013-10-03

    The growing population living with chronic conditions calls for efficient healthcare-planning and effective care. Implementing disease-management-programmes is one option for responding to this demand. Knowledge is scarce about the effect of implementation processes and their effect on patients; only few studies have reported the effectiveness of disease-management-programmes targeting patients with chronic obstructive pulmonary disease (COPD). The objective of this paper was to determine the effect on healthcare-utilization of an active implementation model for a disease-management-programme for patients with one of the major multimorbidity diseases, COPD. The standard implementation of a new disease-management-programme for COPD was ongoing during the study-period from November 2008 to November 2010 in the Central Denmark Region. We wanted to test a strategy using Breakthrough Series, academic detailing and lists of patients with COPD. It targeted GPs and three hospitals serving approx. 60,000 inhabitants aged 35 or older and included interventions directed at professionals, organisations and patients. The study was a non-blinded block- and cluster-randomised controlled trial with GP-practices as the unit of randomisation. In Ringkoebing-Skjern Municipality, Denmark, 16 GP-practices involving 38 GPs were randomised to either the intervention-group or the control-group. A comparable neighbouring municipality acted as an external-control-group which included nine GP-practices with 25 GPs. An algorithm based on health-registry-data on lung-related contacts to the healthcare-system identified 2,736 patients who were alive at the end of the study-period. The population included in this study counted 1,372 (69.2%) patients who responded to the baseline questionnaire and confirmed their COPD diagnosis; 458 (33.4%) patients were from the intervention-group, 376 (27.4%) from the control-group and 538(39.2%) from the external-control-group. The primary outcome was

  20. The effect of an active implementation of a disease management programme for chronic obstructive pulmonary disease on healthcare utilization - a cluster-randomised controlled trial

    PubMed Central

    2013-01-01

    Background The growing population living with chronic conditions calls for efficient healthcare-planning and effective care. Implementing disease-management-programmes is one option for responding to this demand. Knowledge is scarce about the effect of implementation processes and their effect on patients; only few studies have reported the effectiveness of disease-management-programmes targeting patients with chronic obstructive pulmonary disease (COPD). The objective of this paper was to determine the effect on healthcare-utilization of an active implementation model for a disease-management-programme for patients with one of the major multimorbidity diseases, COPD. Methods The standard implementation of a new disease-management-programme for COPD was ongoing during the study-period from November 2008 to November 2010 in the Central Denmark Region. We wanted to test a strategy using Breakthrough Series, academic detailing and lists of patients with COPD. It targeted GPs and three hospitals serving approx. 60,000 inhabitants aged 35 or older and included interventions directed at professionals, organisations and patients. The study was a non-blinded block- and cluster-randomised controlled trial with GP-practices as the unit of randomisation. In Ringkoebing-Skjern Municipality, Denmark, 16 GP-practices involving 38 GPs were randomised to either the intervention-group or the control-group. A comparable neighbouring municipality acted as an external-control-group which included nine GP-practices with 25 GPs. An algorithm based on health-registry-data on lung-related contacts to the healthcare-system identified 2,736 patients who were alive at the end of the study-period. The population included in this study counted 1,372 (69.2%) patients who responded to the baseline questionnaire and confirmed their COPD diagnosis; 458 (33.4%) patients were from the intervention-group, 376 (27.4%) from the control-group and 538(39.2%) from the external-control-group. The primary

  1. A conceptualization of the utility of subjective cognitive decline in clinical trials of preclinical Alzheimer’s disease

    PubMed Central

    Buckley, Rachel F.; Villemagne, Victor L.; Masters, Colin L.; Ellis, Kathryn A.; Rowe, Christopher C.; Johnson, Keith; Sperling, Reisa; Amariglio, Rebecca

    2017-01-01

    Introduction This commentary outlines a conceptual model for subjective cognitive decline (SCD) in relation to Alzheimer’s disease (AD) biomarkers in the preclinical stages of disease, and a framework for effectively utilizing SCD in secondary prevention clinical trials. Objective Mounting evidence supports the notion that SCD is sensitive to encroaching Aβ-amyloid and neurodegeneration. SCD has also been shown to provide additive information of AD-dementia risk beyond what is known about the biomarker status of the individual. Thus, we provide recommendations for the implementing SCD measurement in clinical trials. Results We argue that SCD can be measured at three catch points within the course of the clinical trial; firstly, at the initial recruitment and screening phase, secondly, to create more robust estimates of rates of AD-dementia progression, and finally, to measure subjective experiences of cognitive change and quality of life over the course of the trial as a proxy of clinically meaningful functional improvement. We provide recommendations of how SCD can be approached at each of these points Conclusion SCD is an important component of the preclinical AD-dementia trajectory. Future studies need to elucidate the interactive influence of Aβ-amyloid and tau on SCD from a spatiotemporal perspective. Even as this evidence accrues, it is clear that SCD can provide unique and additive information about rates of progression and subjectively experienced cognitive change within clinical trials. PMID:27514526

  2. Role and clinical utility of pramipexole extended release in the treatment of early Parkinson’s disease

    PubMed Central

    Hametner, Eva-Maria; Seppi, Klaus; Poewe, Werner

    2012-01-01

    The aim of this article is to provide a short review of the most relevant pharmacological and clinical data on pramipexole extended release (ER) as well as to address the clinical utility and potential advantages of a once-daily formulation especially in the treatment of early Parkinson’s disease (PD). Pramipexole is widely established as a symptomatic treatment in early as well as advanced PD. The development of an ER formulation, with stable pramipexole plasma concentration over 24 hours, now offers a bioequivalent once-daily alternative. Double-blind randomized controlled trials in early and advanced PD, have established noninferiority of pramipexole ER compared with immediate release as well as superiority of both formulations over placebo. The overnight switch from the standard to the once-daily formulation was shown to be successful in >80% of patients without requiring any dose adjustments. Potential benefits of the prolonged-release design, which have not yet been formally demonstrated in the pivotal trial program, include improved compliance and a potential for better symptomatic control, particularly in patients with early disease that can be managed with monotherapy. PMID:22500116

  3. Anxiety disorders, physical illnesses, and health care utilization in older male veterans with Parkinson disease and comorbid depression.

    PubMed

    Qureshi, Salah U; Amspoker, Amber B; Calleo, Jessica S; Kunik, Mark E; Marsh, Laura

    2012-12-01

    This study examined the rates of anxiety and depressive disorders, physical illnesses, and health service use in male patients 55 years or older with a diagnosis of Parkinson disease who were seen at least twice at the 10 medical centers in the Veterans Affairs Healthcare Network of the South Central region of the United States. Of the 273 male patients diagnosed between October 1, 1997, and September 30, 2009, 62 (22.7%) had a depressive disorder. The overall prevalence of anxiety disorders was 12.8%; patients with comorbid depression had a 5-fold greater prevalence of anxiety disorders than those without depression (35.5% vs 6.2%, P<.0001). Patients with comorbid depression also had increased prevalence of all physical illnesses examined and more outpatient clinic and mental health visits. Patients with Parkinson disease and comorbid depression are more likely to have anxiety disorders and several physical illnesses, to be using antipsychotic and dementia medicines, and to have increased health service utilization than those without depression.

  4. Awareness, utilization, and determinants of using oral diseases prevention methods among Saudi adults – a clinic-based pilot study

    PubMed Central

    Al-Ansari, Asim

    2016-01-01

    Objectives The present study was conducted to assess the level of awareness and utilization of methods to prevent oral diseases among a group of adult Saudis. Methodology An anonymous, self-administered questionnaire was distributed to patients visiting the clinics of the College of Dentistry, University of Dammam in 2015. The questionnaire assessed the background of the respondents, their dental history, awareness and use of a number of methods available to prevent oral diseases, sources of information about these methods and barriers against their use. Regression analysis was used to assess the factors affecting the use of these practices. Results Brushing was reported to be used by about 60% of respondents whereas fluoride and sealant were less prevalent (≤30%). Dentist was the most frequently reported source of information about preventive methods (60%) and about 40% cited cost and time as the main reasons why they did not use these preventive methods. Awareness and age were associated with using a greater number of the various preventive methods (odds regression coefficient ratio= 0.27 and 0.04). Conclusions Use of preventive methods is not prevalent among Saudi adults and it can be improved by more intensive efforts to increase the awareness of these methods, primarily through dentists. PMID:27004060

  5. The utility of the Dementia Severity Rating Scale in differentiating mild cognitive impairment and Alzheimer disease from controls.

    PubMed

    Mitchell, Joel C; Dick, Malcolm B; Wood, Amanda E; Tapp, Andre M; Ziegler, Raphael

    2015-01-01

    The current study investigated the utility of the Dementia Severity Rating Scale (DSRS) total score to identify individuals at the earliest stage of impairment (ie, mild cognitive impairment/MCI). In addition, the authors sought to investigate how well the measure correlates with an expanded battery of cognitive tests and other measures of functional abilities. Of the 320 participants included in this study, 85 were normal controls, 96 had single-domain or multiple-domain amnestic MCI, and 139 had possible or probable Alzheimer disease (AD). Each participant underwent a thorough cognitive, neurological, and physical examination. Results from this study indicated that the DSRS total scores differed significantly between the 3 groups (P<0.001) and accurately identified 81% of the control group, 60% of the MCI group, and 78% of the AD group in a post hoc discriminant analysis. When combined with a brief cognitive measure (ie, Consortium to Establish a Registry for Alzheimer's Disease Word List 5 min recall test), the DSRS accurately identified 98% of the control group, 76% of the MCI group, and 82% of the AD group. Implications for clinical practice and proposed areas of future research are discussed.

  6. Calibration and evaluation of a flood forecasting system: Utility of numerical weather prediction model, data assimilation and satellite-based rainfall

    NASA Astrophysics Data System (ADS)

    Yucel, I.; Onen, A.; Yilmaz, K. K.; Gochis, D. J.

    2015-04-01

    22.2% when hydrological model calibration is performed with WRF precipitation. Errors were reduced by 36.9% (above uncalibrated model performance) when both WRF model data assimilation and hydrological model calibration was utilized. Our results also indicated that when assimilated precipitation and model calibration is performed jointly, the calibrated parameters at the gauged sites could be transferred to ungauged neighboring basins where WRF-Hydro reduced mean root mean squared error from 8.31 m3/s to 6.51 m3/s.

  7. Making an IMPAKT; Improving care of Chronic Kidney Disease patients in the community through collaborative working and utilizing Information Technology.

    PubMed

    Xu, Gang; Major, Rupert; Shepherd, David; Brunskill, Nigel

    2017-01-01

    Chronic kidney disease (CKD) is a serious long-term condition, which if left untreated causes significant cardiovascular sequele. It is well recognized management of modifiable risk factors, such as blood pressure (BP), can lead to improved long-term outcomes. A novel information technology (IT) solution presents a possible solution to help clinicians in the community identify and manage at risk patients more efficiently. The IMproving Patient care and Awareness of Kidney disease progression Together (IMPAKT) IT tool was used to identify patients with CKD and uncontrolled hypertension in the community. A CKD nurse utilized the tool at primary care practices to identify patients who warranted potential intervention and disseminated this information to clinical staff. Blood pressure management targets and incidence of coded CKD were used to evaluate the project. Altogether 48 practices participated in an 18 month project from April 2014, and data from 20 practices, with a total adult population of 121,362, was available for analysis. Two full consecutive QI (Quality Improvement) audit cycles were completed. There was an increase in the mean recorded prevalence of coded CKD patients over the course of the project. Similarly, there was an increase in the percentage of patients with BP been recorded and importantly there was an accompanying significant increase in CKD patients achieving BP targets. At the end of the project an additional 345 individuals with CKD achieved better blood pressure control. This could potentially prevent 9 cardiovascular events in the CKD group, translating to a cost saving of £320,000 for the 20 practices involved. The most significant change in clinical markers occurred during cycle 1 of the audit, the improvement was maintained throughout cycle 2 of the audit. Our results show the real-life clinical impact of a relatively simple and easy to implement QI project, to help improve outcomes in patients with CKD. This was achieved through more

  8. Making an IMPAKT; Improving care of Chronic Kidney Disease patients in the community through collaborative working and utilizing Information Technology

    PubMed Central

    Xu, Gang; Major, Rupert; Shepherd, David; Brunskill, Nigel

    2017-01-01

    Chronic kidney disease (CKD) is a serious long-term condition, which if left untreated causes significant cardiovascular sequele. It is well recognized management of modifiable risk factors, such as blood pressure (BP), can lead to improved long-term outcomes. A novel information technology (IT) solution presents a possible solution to help clinicians in the community identify and manage at risk patients more efficiently. The IMproving Patient care and Awareness of Kidney disease progression Together (IMPAKT) IT tool was used to identify patients with CKD and uncontrolled hypertension in the community. A CKD nurse utilized the tool at primary care practices to identify patients who warranted potential intervention and disseminated this information to clinical staff. Blood pressure management targets and incidence of coded CKD were used to evaluate the project. Altogether 48 practices participated in an 18 month project from April 2014, and data from 20 practices, with a total adult population of 121,362, was available for analysis. Two full consecutive QI (Quality Improvement) audit cycles were completed. There was an increase in the mean recorded prevalence of coded CKD patients over the course of the project. Similarly, there was an increase in the percentage of patients with BP been recorded and importantly there was an accompanying significant increase in CKD patients achieving BP targets. At the end of the project an additional 345 individuals with CKD achieved better blood pressure control. This could potentially prevent 9 cardiovascular events in the CKD group, translating to a cost saving of £320,000 for the 20 practices involved. The most significant change in clinical markers occurred during cycle 1 of the audit, the improvement was maintained throughout cycle 2 of the audit. Our results show the real-life clinical impact of a relatively simple and easy to implement QI project, to help improve outcomes in patients with CKD. This was achieved through more

  9. Prognostic Utility of Calcium Scoring as an Adjunct to Stress Myocardial Perfusion Scintigraphy in End-Stage Renal Disease.

    PubMed

    Moody, William E; Lin, Erica L S; Stoodley, Matthew; McNulty, David; Thomson, Louise E; Berman, Daniel S; Edwards, Nicola C; Holloway, Benjamin; Ferro, Charles J; Townend, Jonathan N; Steeds, Richard P

    2016-05-01

    Coronary artery calcium score (CACS) is a strong predictor of adverse cardiovascular events in the general population. Recent data confirm the prognostic utility of single-photon emission computed tomographic (SPECT) imaging in end-stage renal disease, but whether performing CACS as part of hybrid imaging improves risk prediction in this population is unclear. Consecutive patients (n = 284) were identified after referral to a university hospital for cardiovascular risk stratification in assessment for renal transplantation. Participants underwent technetium-99m SPECT imaging after exercise or standard adenosine stress in those unable to achieve 85% maximal heart rate; multislice CACS was also performed (Siemens Symbia T16, Siemens, Erlangen, Germany). Subjects with known coronary artery disease (n = 88) and those who underwent early revascularization (n = 2) were excluded. The primary outcome was a composite of death or first myocardial infarction. An abnormal SPECT perfusion result was seen in 22% (43 of 194) of subjects, whereas 45% (87 of 194) had at least moderate CACS (>100 U). The frequency of abnormal perfusion (summed stress score ≥4) increased with increasing CACS severity (p = 0.049). There were a total of 15 events (8 deaths, and 7 myocardial infarctions) after a median duration of 18 months (maximum follow-up 3.4 years). Univariate analysis showed diabetes mellitus (Hazard ratio [HR] 3.30, 95% CI 1.14 to 9.54; p = 0.028), abnormal perfusion on SPECT (HR 5.32, 95% CI 1.84 to 15.35; p = 0.002), and moderate-to-severe CACS (HR 3.55, 95% CI 1.11 to 11.35; p = 0.032) were all associated with the primary outcome. In a multivariate model, abnormal perfusion on SPECT (HR 4.18, 95% CI 1.43 to 12.27; p = 0.009), but not moderate-to-severe CACS (HR 2.50, 95% CI 0.76 to 8.20; p = 0.130), independently predicted all-cause death or myocardial infarction. The prognostic value of CACS was not incremental to clinical and SPECT perfusion data (global chi-square change

  10. Burden of illness, annual healthcare utilization, and costs associated with commercially insured patients with Cushing disease in the United States.

    PubMed

    Broder, Michael S; Neary, Maureen P; Chang, Eunice; Cherepanov, Dasha; Ludlam, William H

    2015-01-01

    To describe the burden of illness, healthcare utilization, and costs associated with Cushing disease (CD), a rare disorder resulting from adrenocorticotropic hormone-secreting pituitary tumors, in commercially insured patients in the U. S. Patients with CD were identified in 2010 in the IMS Health PharMetrics and Truven Health Analytics MarketScan claims databases. Because there is no diagnosis code for CD, patients were identified with a claim for Cushing syndrome and either benign pituitary adenoma or hypophysectomy. We estimated total and CD-related utilization and costs using pharmacy and medical claims. We identified 685 CD patients (81% female; mean age, 41.7 years; mean Charlson comorbidity index, 1.6; mean number of chronic conditions, 4.2); 30.5% of the patients had diabetes, 22.5% had psychiatric disturbances, 21% had infections, 8.6% had osteoporosis, 8% had cardiovascular disease/stroke, 5.5% had kidney stones, and 0.7% had compression fracture of a vertebra. Patients had a mean of 19.8 office visits per year; 38.4% had inpatient hospitalizations and 34.2% visited the emergency department (ED). Patients had a mean of 3.2 CD-related office visits per year; 26.9% had CD-related hospitalizations, 0.9% had CD-related ED visits, and 36.8% had CD treatments. Mean annual total costs were $34,992 (pharmacy, $3,597; medical costs, $31,395). CD-related costs accounted for $14,310 of total costs (CD treatment costs, $9,353; other CD-related costs, $4,957). CD patients have a high burden of illness. Among CD patients in this study, 30.5% had diabetes, 22.5% had psychiatric disturbances, 21% had infections, 8.6% had osteoporosis, 8% had cardiovascular disease/stroke, and 5.5% had kidney stones. Patients had 19.8 office visits per year, and >34% of patients were hospitalized. Mean total cost of care was approximately $35,000 per year.

  11. Clinical utility of the functional independence measure for assessment of patients with Alzheimer's disease and vascular dementia.

    PubMed

    Tanaka, Naofumi; Nakatsuka, Masahiro; Ishii, Hiroshi; Nakayama, Rie; Hosaka, Ryoko; Meguro, Kenichi

    2013-12-01

    The aim of this study was to investigate the clinical utility of the Functional Independence Measure (FIM), and especially FIM-Cognition (FIM-C) scores, in patients with Alzheimer's disease (AD) and vascular dementia (VaD), and to determine the influence of behavioural and psychological symptoms of dementia (BPSD) on FIM-C scores. This was a cross-sectional survey of 37 AD and 40 VaD patients. Cognitive function was assessed with the Cognitive Abilities Screening Instrument. Activities of daily living were evaluated with the FIM and the Barthel Index. BPSD were assessed with the Behavioural Pathology in Alzheimer's Disease Frequency Weighted Severity Scale. For both groups, Spearman's correlations were found between FIM-Motor and Barthel Index scores and between FIM-C and Mini Mental State Examination scores. Each FIM-C subscore was correlated with Cognitive Abilities Screening Instrument scores in both groups, except for the FIM-C Social interaction subscore in VaD. VaD patients showing Activity Disturbance and Aggressiveness on the Behavioural Pathology in Alzheimer's Disease Frequency Weighted Severity Scale had significantly lower FIM-C Memory and Social interaction subscores than those without BPSD. The results suggest that the FIM-Motor and FIM-C scales are useful measures of physical and cognitive disabilities in patients with AD and VaD. The FIM-C profile of AD may reflect global cognitive function, while that of VaD may be more influenced by BPSD. © 2013 The Authors. Psychogeriatrics © 2013 Japanese Psychogeriatric Society.

  12. Palliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life.

    PubMed

    Patel, Arpan A; Walling, Anne M; Ricks-Oddie, Joni; May, Folasade P; Saab, Sammy; Wenger, Neil

    2017-10-01

    There has been increased attention on ways to improve the quality of end-of-life care for patients with end-stage liver disease; however, there have been few reports of care experiences for patients during terminal hospitalizations. We analyzed data from a large national database to increase our understanding of palliative care for and health care utilization by patients with end-stage liver disease. We performed a cross-sectional, observational study to examine terminal hospitalizations of adults with decompensated cirrhosis using data from the National Inpatient Sample from 2009 through 2013. We collected data on palliative care consultation and total hospital costs, and performed multivariate regression analyses to identify factors associated with palliative care consultation. We also investigated whether consultation was associated with lower costs. Among hospitalized adults with terminal decompensated cirrhosis, 30.3% received palliative care; the mean cost per hospitalization was $48,551 ± $1142. Palliative care consultation increased annually, and was provided to 18.0% of patients in 2009 and to 36.6% of patients in 2013 (P < .05). The mean cost for the terminal hospitalization did not increase significantly ($47,969 in 2009 to $48,956 in 2013, P = .77). African Americans, Hispanics, Asians, and liver transplant candidates were less likely to receive palliative care, whereas care in large urban teaching hospitals was associated with a higher odds of receiving consultation. Palliative care was associated with lower procedure burden-after adjusting for other factors, palliative care was associated with a cost reduction of $10,062. Palliative care consultation for patients with end-stage liver disease increased from 2009 through 2013. Palliative care consultation during terminal hospitalizations is associated with lower costs and procedure burden. Future research should evaluate timing and effects of palliative care on quality of end-of-life care in this

  13. Multicenter COMPACT study of COMplications in patients with sickle cell disease and utilization of iron chelation therapy.

    PubMed

    Jordan, Lanetta; Adams-Graves, Patricia; Kanter-Washko, Julie; Oneal, Patricia A; Sasane, Medha; Vekeman, Francis; Bieri, Christine; Magestro, Matthew; Marcellari, Andrea; Duh, Mei Sheng

    2015-03-01

    Over the past few decades, lifespans of sickle cell disease (SCD) patients have increased; hence, they encounter multiple complications. Early detection, appropriate comprehensive care, and treatment may prevent or delay onset of complications. We collected longitudinal data on sickle cell disease (SCD) complication rates and associated resource utilization relative to blood transfusion patterns and iron chelation therapy (ICT) use in patients aged ≥16 years to address a gap in the literature. Medical records of 254 SCD patients ≥16 years were retrospectively reviewed at three US tertiary care centers. We classified patients into cohorts based on cumulative units of blood transfused and ICT history: <15 units, no ICT (Cohort 1 [C1]), ≥15 units, no ICT (Cohort 2 [C2]), and ≥15 units with ICT (Cohort 3 [C3]). We report SCD complication rates per patient per year; cohort comparisons use rate ratios (RRs). Cohorts had 69 (C1), 91 (C2), and 94 (C3) patients. Pain led to most hospitalizations (76%) and emergency department (ED) (82%) visits. Among transfused patients (C2+C3), those receiving ICT were less likely to experience SCD complications than those who did not (RR [95% CI] C2 vs. C3: 1.33 [1.25-1.42]). Similar trends (RR [95% CI]) were observed in ED visits and hospitalizations associated with SCD complications (C2 vs. C3, ED: 1.94 [1.70-2.21]; hospitalizations: 1.61 [1.45-1.78]), but not in outpatient visits. Although the most commonly reported SCD complication among all patients was pain, patients who received ICT were less likely to experience pain and other complications than those who did not. These results highlight the need for increased patient and provider education on the importance of comprehensive disease management.

  14. Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening.

    PubMed

    Davies, Jane H; Kenkre, Joyce; Williams, E Mark

    2014-04-17

    Peripheral arterial disease (PAD) is a marker of systemic atherosclerosis and associated with a three to six fold increased risk of death from cardiovascular causes. Furthermore, it is typically asymptomatic and under-diagnosed; this has resulted in escalating calls for the instigation of Primary Care PAD screening via Ankle Brachial Index (ABI) measurement. However, there is limited evidence regarding the feasibility of this and if the requisite core skills and knowledge for such a task already exist within primary care. This study aimed to determine the current utility of ABI measurement in general practices across Wales, with consideration of the implications for its use as a cardiovascular risk screening tool. A self-reporting questionnaire was distributed to all 478 General Practices within Wales, sent via their responsible Health Boards. The survey response rate was 20%. ABI measurement is primarily performed by nurses (93%) for the purpose of wound management (90%). It is infrequently (73% < 4 times per month) and often incorrectly used (42% out of compliance with current ABI guidance). Only 52% of general practitioners and 16% of nurses reported that patients with an ABI of ≤ 0.9 require aggressive cardiovascular disease risk factor modification (as recommended by current national and international guidelines). ABI measurement is an under-utilised and often incorrectly performed procedure in the surveyed general practices. Prior to its potential adoption as a formalised screening tool for cardiovascular disease, there is a need for a robust training programme with standardised methodology in order to optimise accuracy and consistency of results. The significance of a diagnosis of PAD, in terms of associated increased cardiovascular risk and the necessary risk factor modification, needs to be highlighted.

  15. Using qualitative methods to inform the trade-off between content validity and consistency in utility assessment: the example of type 2 diabetes and Alzheimer's Disease

    PubMed Central

    2010-01-01

    Background Key stakeholders regard generic utility instruments as suitable tools to inform health technology assessment decision-making regarding allocation of resources across competing interventions. These instruments require a 'descriptor', a 'valuation' and a 'perspective' of the economic evaluation. There are various approaches that can be taken for each of these, offering a potential lack of consistency between instruments (a basic requirement for comparisons across diseases). The 'reference method' has been proposed as a way to address the limitations of the Quality-Adjusted Life Year (QALY). However, the degree to which generic measures can assess patients' specific experiences with their disease would remain unresolved. This has been neglected in the discussions on methods development and its impact on the QALY values obtained and resulting cost per QALY estimate underestimated. This study explored the content of utility instruments relevant to type 2 diabetes and Alzheimer's disease (AD) as examples, and the role of qualitative research in informing the trade-off between content coverage and consistency. Method A literature review was performed to identify qualitative and quantitative studies regarding patients' experiences with type 2 diabetes or AD, and associated treatments. Conceptual models for each indication were developed. Generic- and disease-specific instruments were mapped to the conceptual models. Results Findings showed that published descriptions of relevant concepts important to patients with type 2 diabetes or AD are available for consideration in deciding on the most comprehensive approach to utility assessment. While the 15-dimensional health related quality of life measure (15D) seemed the most comprehensive measure for both diseases, the Health Utilities Index 3 (HUI 3) seemed to have the least coverage for type 2 diabetes and the EuroQol-5 Dimensions (EQ-5D) for AD. Furthermore, some of the utility instruments contained items that

  16. Satellite Upper Air Network (SUAN)

    NASA Astrophysics Data System (ADS)

    Reale, Tony L.; Thorne, Peter

    2004-10-01

    During the past 20 years of NOAA operational polar satellites, it has become evident that a growing problem concerning their utilization in Climate and also Numerical Weather Prediction (NWP) applications are the systematic errors and uncertainties inherent in the satellite measurements. Similar arguments can be made for global radiosonde observations. These uncertainties are often larger than the sensitive signals and processes, that satellite and radiosonde measurements are designed to reveal, particularly in the realm of climate. Possible strategies to quantify and compensate for these problems include the analysis of satellite overlap data and/or available collocations of satellite and ground truth (radiosonde) observations. However, overlap observations are typically not available except in extreme polar regions and current sampling strategies for compiling collocated radiosonde and satellite observations are insufficient, further compounding the inherent uncertainties in the ground-truth radiosonde data. A Satellite Upper Air Network is proposed to provide reference radiosonde launches coincident with operational polar satellite(s) overpass. The SUAN consist of 36 global radiosonde stations sub-sampled from the Global Upper Air Network (GUAN), and is designed to provide a robust, global sample of collocated radiosonde and satellite observations conducive to the monitoring and validation of satellite and radiosonde observations. The routine operation of such a network in conjunction with operational polar satellites would provide a long-term of performance for critical observations of particular importance for climate. The following report presents a candidate network of 36 upper-air sites that could comprise a SUAN. Their selection along with the mutual benefit across the satellite, radiosonde, climate, numerical weather prediction (NWP) and radiative transfer (RT) model areas are discussed.

  17. Health State Utility Value in Chronic Obstructive Pulmonary Disease (COPD); The Challenge of Heterogeneity: A Systematic Review and Meta-Analysis.

    PubMed

    Moayeri, Foruhar; Hsueh, Ya-Seng Arthur; Clarke, Philip; Hua, Xinyang; Dunt, David

    2016-06-01

    Chronic obstructive pulmonary disease (COPD) has a considerable impact on quality of life and well-being of patients. Health state utility value (HSUV) is a recognized measure for health economic appraisals and is extensively used as an indicator for decision-making studies. This study is a systematic review of literature aimed to estimate mean utility value in COPD using meta-analysis and explore degree of heterogeneity in the utility values across a variety of clinical and study characteristic. The literature review covers studies that used EQ-5D to estimate utility value for patient level research in COPD. Studies that reported utility values elicited by EQ-5D in COPD patients were selected for random-effect meta-analysis addressing inter-study heterogeneity and subgroup analyses. Thirty-two studies were included in the general utility meta-analysis. The estimated general utility value was 0.673 (95% CI 0.653 to 0.693). Meta-analyses of COPD stages utility values showed influence of airway obstruction on utility value. The utility values ranged from 0.820 (95% CI 0.767 to 0.872) for stage I to 0.624 (95% CI 0.571 to 0.677) for stage IV. There was substantial heterogeneity in utility values: I(2) = 97.7%. A more accurate measurement of utility values in COPD is needed to refine valid and generalizable scores of HSUV. Given the limited success of the factors studied to reduce heterogeneity, an approach needs to be developed how best to use mean utility values for COPD in health economic evaluation.

  18. Reference standard space hippocampus labels according to the European Alzheimer's Disease Consortium-Alzheimer's Disease Neuroimaging Initiative harmonized protocol: Utility in automated volumetry.

    PubMed

    Wolf, Dominik; Bocchetta, Martina; Preboske, Gregory M; Boccardi, Marina; Grothe, Michel J

    2017-08-01

    A harmonized protocol (HarP) for manual hippocampal segmentation on magnetic resonance imaging (MRI) has recently been developed by an international European Alzheimer's Disease Consortium-Alzheimer's Disease Neuroimaging Initiative project. We aimed at providing consensual certified HarP hippocampal labels in Montreal Neurological Institute (MNI) standard space to serve as reference in automated image analyses. Manual HarP tracings on the high-resolution MNI152 standard space template of four expert certified HarP tracers were combined to obtain consensual bilateral hippocampus labels. Utility and validity of these reference labels is demonstrated in a simple atlas-based morphometry approach for automated calculation of HarP-compliant hippocampal volumes within SPM software. Individual tracings showed very high agreement among the four expert tracers (pairwise Jaccard indices 0.82-0.87). Automatically calculated hippocampal volumes were highly correlated (rL/R = 0.89/0.91) with gold standard volumes in the HarP benchmark data set (N = 135 MRIs), with a mean volume difference of 9% (standard deviation 7%). The consensual HarP hippocampus labels in the MNI152 template can serve as a reference standard for automated image analyses involving MNI standard space normalization. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  19. Health care utilization, costs, and the burden of disease related to eosinophilic esophagitis in the United States

    PubMed Central

    Jensen, Elizabeth T.; Kappelman, Michael D.; Martin, Christopher F.; Dellon, Evan S.

    2015-01-01

    Objectives Eosinophilic esophagitis (EoE) has rapidly become a major cause of upper GI morbidity, but health care costs related to EoE have not been described. This study aimed to estimate EoE-related health care costs and utilization in the United States. Methods We performed a study of health care utilization of EoE cases compared to age- and sex-matched controls using administrative claims data, representative of the commercially insured population in the U.S. Cases of EoE were identified using a previously validated definition. We assessed inpatient, outpatient, emergency department, outpatient prescription, and endoscopy-related costs for patients with EoE, and estimated total costs related to EoE extrapolated to the U.S. population. Results We identified 8,135 cases of EoE and 32,540 controls. The median total annual cost per EoE case was $3,304 compared to $1,001 for controls (p<0.001). For EoE, median costs included $2,508/year for outpatient visits, $157 for endoscopies, and $325 for pharmacy claims, compared to $699, $0, and $76 for controls (p<0.001 for all). The overall median costs associated with EoE were $2,302/year/patient. Total costs in the U.S. ranged from $503 million to $1.36 billion/year, depending on the prevalence estimate, with costs attributable to EoE ranging from $350-$947 million/year. Conclusions Patients with EoE have an estimated annual health care cost of as much as $1.4 billion in the U.S. This represents a remarkable burden of disease for an entity that was essentially unknown two decades ago. These cost data can be used by policy makers to guide resource allocation. PMID:25267327

  20. Anxiety associations with cardiac symptoms, angiographic disease severity, and healthcare utilization: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation.

    PubMed

    Rutledge, Thomas; Kenkre, Tanya S; Bittner, Vera; Krantz, David S; Thompson, Diane V; Linke, Sarah E; Eastwood, Jo-Ann; Eteiba, Wafia; Cornell, Carol E; Vaccarino, Viola; Pepine, Carl J; Johnson, B Delia; Bairey Merz, C Noel

    2013-10-03

    Anxiety is common among patients presenting with suspected coronary artery disease (CAD). In a sample of women with signs and symptoms of ischemia, we examined three anxiety markers as predictors of CAD endpoints including: 1) cardiac symptom indicators; 2) angiographic CAD severity; and 3) healthcare utilization (cardiac hospitalizations and 5-year cardiovascular [CVD] healthcare costs). Participants completed a baseline protocol including coronary angiogram, cardiac symptoms, psychosocial measures and a median 5.9-year follow-up to track hospitalizations. We calculated CVD costs based on cardiac hospitalizations, treatment visits, and CVD medications. Anxiety measures included anxiolytic medication use, Spielberger Trait Anxiety Inventory (STAI) scores, and anxiety disorder treatment history. The sample numbered 514 women with anxiety measure data and covariates (mean age=57.5 [11.1]). One in five (20.4%) women reported using anxiolytic agents. Anxiety correlated with cardiac symptom indicators (anxiolytic use with nighttime angina and nitroglycerine use; STAI scores and anxiety disorder treatment history with nighttime angina, shortness of breath, and angina frequency). Anxiety disorder treatment history (but not STAI scores or anxiolytics) predicted less severe CAD. Anxiolytic use (but not STAI scores or anxiety disorder treatment history) predicted hospitalizations for chest pain and coronary catheterization (HRs=2.0, 95% CIs=1.1-4.7). Anxiety measures predicted higher 5-year CVD costs (+9.0-42.7%) irrespective of CAD severity. Among women with signs and symptoms of myocardial ischemia, anxiety measures predict cardiac endpoints ranging from cardiac symptom severity to healthcare utilization. Based on these findings, anxiety may warrant greater consideration among women with suspected CAD. Published by Elsevier Ireland Ltd.

  1. Variations in care: a retrospective database analysis of healthcare utilization patterns for patients with inflammatory bowel disease.

    PubMed

    David, Guy; Gunnarsson, Candace; Lofland, Jennifer H

    2015-02-01

    Biologic therapy has been shown to be effective in achieving and maintaining remission in the treatment of inflammatory bowel disease (IBD). However, their impact on healthcare resource utilization is not well understood. This study explored the impact of biologic use on IBD-related hospital admissions and emergency room visits and healthcare expenditures. This study used a retrospective cohort design to analyze data from the MarketScan Commercial and Medicare databases (Truven Health Analytics Inc.) for the years 2006-2010. Patients were identified using ICD-9 diagnosis codes for IBD and age 18 or older at time of initial diagnosis. Linear models were used to predict the probability of an IBD-related hospitalization or ER visit and healthcare expenditures with binary variables indicating use of biologics in the current year and in the previous 2 years, as well as patient- and area-level control variables. Patients using biologics in the current year were 14.1-17.6% more likely to be hospitalized for IBD. However, biologic use in the previous year was associated with a 3.8-5.6% reduction in hospitalizations, and biologic use 2 years prior was associated with a 1-2.8% reduction in hospitalizations in the current year. Similar results are found for ER visits. All indicators for biologic use were associated with increased expenditures. There was a negative association between lagged use of biologics and the proportion of patients with IBD-related hospitalizations and ER visits. This finding may suggest that increased use of biologics over time is associated with a decrease in IBD-related healthcare utilization.

  2. A comparison of early diagnostic utility of Alzheimer disease biomarkers in brain magnetic resonance and cerebrospinal fluid.

    PubMed

    Monge Argilés, J A; Blanco Cantó, M A; Leiva Salinas, C; Flors, L; Muñoz Ruiz, C; Sánchez Payá, J; Gasparini Berenguer, R; Leiva Santana, C

    2014-09-01

    The goals of this study were to compare the early diagnostic utility of Alzheimer disease biomarkers in the CSF with those in brain MRI in conditions found in our clinical practice, and to ascertain the diagnostic accuracy of both techniques used together. Between 2008 and 2009, we included 30 patients with mild cognitive impairment (MCI) who were examined using 1.5 Tesla brain MRI and AD biomarker analysis in CSF. MRI studies were evaluated by 2 radiologists according to the Korf́s visual scale. CSF biomarkers were analysed using INNOTEST reagents for Aβ1-42, total-tau and phospho-tau181p. We evaluated clinical changes 2 years after inclusion. By 2 years after inclusion, 15 of the original 30 patients (50%) had developed AD (NINCDS-ADRA criteria). The predictive utility of AD biomarkers in CSF (RR 2.7; 95% CI, 1.1-6.7; P<.01) was greater than that of MRI (RR 1.5; 95% CI 95%, 0.7-3.4; P<.2); using both techniques together yielded a sensitivity and a negative predictive value of 100%. Normal results on both complementary tests ruled out progression to AD (100%) within 2 years of inclusion. Our results show that the diagnostic accuracy of biomarkers in CSF is higher than that of biomarkers in MRI. Combined use of both techniques is highly accurate for either early diagnosis or exclusion of AD in patients with MCI. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  3. Anxiety Associations with Cardiac Symptoms, Angiographic Disease Severity, & Healthcare Utilization: The NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation

    PubMed Central

    Rutledge, Thomas; Kenkre, Tanya S.; Bittner, Vera; Krantz, David S.; Thompson, Diane V.; Linke, Sarah E.; Eastwood, Jo-Ann; Eteiba, Wafia; Cornell, Carol E.; Vaccarino, Viola; Pepine, Carl J.; Johnson, B. Delia; Merz, C. Noel Bairey

    2013-01-01

    Background Anxiety is common among patients presenting with suspected coronary artery disease (CAD). In a sample of women with signs and symptoms of ischemia, we examined three anxiety markers as predictors of CAD endpoints including: 1) cardiac symptom indicators; 2) angiographic CAD severity; and 3) healthcare utilization (cardiac hospitalizations & 5-year cardiovascular [CVD] healthcare costs). Methods Participants completed a baseline protocol including coronary angiogram, cardiac symptoms, psychosocial measures and a median 5.9-year follow-up to track hospitalizations. We calculated CVD costs based on cardiac hospitalizations, treatment visits, and CVD medications. Anxiety measures included anxiolytic medication use, Spielberger Trait Anxiety Inventory (STAI) scores, and anxiety disorder treatment history. Results The sample numbered 514 women with anxiety measure data and covariates (mean age=57.5[11.1]). One in five (20.4%) women reported using anxiolytic agents. Anxiety correlated with cardiac symptom indicators (anxiolytic use with nighttime angina & nitroglycerine use; STAI scores & anxiety disorder treatment history with nighttime angina, shortness of breath, & angina frequency). Anxiety disorder treatment history (but not STAI scores or anxiolytics) predicted less severe CAD. Anxiolytic use (but not STAI scores or anxiety disorder treatment history) predicted hospitalizations for chest pain and coronary catheterization (HR’s=2.0, 95% CI’s=1.1–4.7). Anxiety measures predicted higher 5-year CVD costs (+9.0–42.7%) irrespective of CAD severity. Conclusions Among women with signs and symptoms of myocardial ischemia, anxiety measures predict cardiac endpoints ranging from cardiac symptom severity to healthcare utilization. Based on these findings, anxiety may warrant greater consideration among women with suspected CAD. PMID:23410495

  4. Association Between Satellite-based Estimates of Long-term PM2.5 Exposure and Coronary Artery Disease

    EPA Science Inventory

    Background: Epidemiological studies have identified associations between long-term PM2.5 exposure and cardiovascular events, though most have relied on concentrations from central-site air quality monitors. Methods: We utilized a cohort of 5679 patients who had undergone cardiac ...

  5. Association Between Satellite-based Estimates of Long-term PM2.5 Exposure and Coronary Artery Disease

    EPA Science Inventory

    Background: Epidemiological studies have identified associations between long-term PM2.5 exposure and cardiovascular events, though most have relied on concentrations from central-site air quality monitors. Methods: We utilized a cohort of 5679 patients who had undergone cardiac ...

  6. Satellite Videoconferences

    NASA Technical Reports Server (NTRS)

    1990-01-01

    NASA is helping thousands of teachers to learn more about aerospace matters, improve their classroom skills, and expand significantly the content of their aerospace education curricula by means of live educational satellite videoconferences. The 1 1/2 hour 'Update for Teachers' programs originate at Oklahoma State University (OSU) Telecommunications Center. The television signals are transmitted to the WESTAR IV communications satellite, which remits them to participating schools across the U.S. and in parts of Mexico and Canada. The schools are equipped with small home style satellite reception dishes. Education Satellite Videoconference programs are conducted four times yearly, covering a variety of aerospace subjects. Teachers can call toll-free and have questions answered after the speaker's presentations. Information about NASA educational resources and how to obtain them will be provided.

  7. Satellite (Natural)

    NASA Astrophysics Data System (ADS)

    Murdin, P.

    2000-11-01

    In its most general sense, any celestial object in orbit around a similar larger object. Thus, for example, the Magellanic Clouds are satellite galaxies of our own Milky Way galaxy. Without qualification, the term is used to mean a body in orbit around a planet; an alternative term is moon. The term natural satellite distinguishes these bodies from artificial satellites—spacecraft placed in orbi...

  8. Utility of PET/CT After Cryoablation for Early Identification of Local Tumor Progression in Osseous Metastatic Disease.

    PubMed

    Packard, Ann T; Broski, Stephen M; Callstrom, Matthew R; Atwell, Thomas D; Schmit, Grant D; Schmitz, John J; Morris, Jonathan M; Hunt, Christopher H; Kurup, A Nicholas

    2017-06-01

    The purpose of this study is to evaluate the utility of combined PET/CT for the detection of early local tumor progression after cryoablation of bone metastases. A retrospective single-institution review revealed 61 consecutive patients with 80 separate bone metastases treated with cryoablation who were evaluated with a preablation PET/CT and at least two postablation PET/CT examinations between September 2007 and July 2015. Patients were excluded if they had local therapy or pathologic fracture after ablation. The patients were grouped according to postcryoablation disease status (i.e., local tumor progression or not) and PET radiotracer (i.e., (11)C-choline or (18)F-FDG) used. The maximum standardized uptake value (SUVmax) ratio (i.e., ratio of SUVmax to blood pool) was calculated within each osseous metastasis before and after cryoablation, and these were then compared between groups. Of the 61 patients and 80 ablations performed, 32 patients were imaged with FDG PET/CT and 29 were imaged with (11)C-choline PET/CT. Twenty-three patients imaged with FDG and 13 patients imaged with (11)C-choline had evidence of local tumor progression on all postablation PET/CT examinations. The SUVmax ratio was significantly higher in patients with local tumor progression on the first and most remote postcryoablation PET/CT examinations for both FDG and (11)C-choline (p < 0.001 in all cases). There was no significant difference in the postablation systemic therapy between the groups with and without local tumor progression. Increased SUVmax ratio in patients after cryoablation for osseous metastatic disease should raise concern about local tumor progression independently of time after ablation.

  9. Cardiac implantable electronic device remote monitoring surveillance in pediatric and congenital heart disease: Utility relative to frequency.

    PubMed

    Dechert, Brynn E; Serwer, Gerald A; Bradley, David J; Dick, Macdonald; LaPage, Martin J

    2015-01-01

    Heart Rhythm Society expert consensus provides recommendations for surveillance monitoring of cardiac implantable electronic devices (CIEDs), but limited data are available for the pediatric and congenital heart disease population. The purpose of this study was to determine the rate of actionable events during CIED surveillance in this population, assess the utility of routine CIED remote monitoring, and assess the potential benefit from more frequent monitoring. This was a retrospective cohort study of all CIED patients followed at a pediatric and congenital heart center and enrolled in the Medtronic Carelink system with either (1) a chronic (implanted for >6 months) CIED followed between July 1, 2010, and July 1, 2012, on a bimonthly schedule; or (2) a new CIED (implanted <6 months) between July 1, 2008, and July 1, 2012, followed on a monthly schedule. Aggregate mean age was 20 ± 13.7 years. There were 608 interrogations on newly implanted CIEDs with an actionable event rate of 11 per 100 patient-years. There were 2614 interrogations of chronic CIEDs with an actionable event rate of 22 per 100 patient-years. The odds of an actionable event on an asymptomatic remote monitoring transmission was lower than if symptomatic (odds ratio 0.04, 95% confidence interval 0.03-0.07). Tachyarrhythmia was the most common event. Predictors of actionable events were identified. In this population of pediatric and congenital heart disease patients, the rate of actionable events was low, especially on asymptomatic interrogations. Most actionable events were due to tachyarrhythmia. A more frequent than every 90-day monitoring schedule does not appear to be of significant benefit. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  10. Japan's efforts to promote global health using satellite remote sensing data from the Japan Aerospace Exploration Agency for prediction of infectious diseases and air quality.

    PubMed

    Igarashi, Tamotsu; Kuze, Akihiko; Sobue, Shinichi; Yamamoto, Aya; Yamamoto, Kazuhide; Oyoshi, Kei; Imaoka, Keiji; Fukuda, Toru

    2014-12-01

    In this paper we review the status of new applications research of the Japanese Aerospace Exploration Agency (JAXA) for global health promotion using information derived from Earth observation data by satellites in cooperation with inter-disciplinary collaborators. Current research effort at JAXA to promote global public health is focused primarily on the use of remote sensing to address two themes: (i) prediction models for malaria and cholera in Kenya, Africa; and (ii) air quality assessment of small, particulate matter (PM2.5), nitrogen dioxide (NO2) and ozone (O3). Respiratory and cardivascular diseases constitute cross-boundary public health risk issues on a global scale. The authors report here on results of current of a collaborative research to call attention to the need to take preventive measures against threats to public health using newly arising remote sensing information from space.

  11. Utility of Iron Staining in Identifying the Cause of Renal Allograft Dysfunction in Patients with Sickle Cell Disease

    PubMed Central

    Wang, Yingchun; Khan, Salman; Li, Wei; Zhang, Ping L.

    2015-01-01

    Sickle cell nephropathy (SCN) is associated with iron/heme deposition in proximal renal tubules and related acute tubular injury (ATI). Here we report the utility of iron staining in differentiating causes of renal allograft dysfunction in patients with a history of sickle cell disease. Case 1: the patient developed acute allograft dysfunction two years after renal transplant. Her renal biopsy showed ATI, supported by patchy loss of brush border and positive staining of kidney injury molecule-1 in proximal tubular epithelial cells, where diffuse increase in iron staining (2+) was present. This indicated that ATI likely resulted from iron/heme toxicity to proximal tubules. Electron microscope confirmed aggregated sickle RBCs in glomeruli, indicating a recurrent SCN. Case 2: four years after renal transplant, the patient developed acute allograft dysfunction and became positive for serum donor-specific antibody. His renal biopsy revealed thrombotic microangiopathy (TMA) and diffuse positive C4d stain in peritubular capillaries. Iron staining was negative in the renal tubules, implying that TMA was likely associated with acute antibody-mediated rejection (AAMR, type 2) rather than recurrent SCN. These case reports imply that iron staining is an inexpensive but effective method in distinguishing SCN-associated renal injury in allograft kidney from other etiologies. PMID:26697257

  12. Cost-Utility Analysis of Telemonitoring Interventions for Patients with Chronic Obstructive Pulmonary Disease (COPD) in Germany.

    PubMed

    Hofer, Florian; Achelrod, Dmitrij; Stargardt, Tom

    2016-12-01

    Chronic obstructive pulmonary disease (COPD) poses major challenges for health care systems. Previous studies suggest that telemonitoring could be effective in preventing hospitalisations and hence reduce costs. The aim was to evaluate whether telemonitoring interventions for COPD are cost-effective from the perspective of German statutory sickness funds. A cost-utility analysis was conducted using a combination of a Markov model and a decision tree. Telemonitoring as add-on to standard treatment was compared with standard treatment alone. The model consisted of four transition stages to account for COPD severity, and a terminal stage for death. Within each cycle, the frequency of exacerbations as well as outcomes for 2015 costs and quality adjusted life years (QALYs) for each stage were calculated. Values for input parameters were taken from the literature. Deterministic and probabilistic sensitivity analyses were conducted. In the base case, telemonitoring led to an increase in incremental costs (€866 per patient) but also in incremental QALYs (0.05 per patient). The incremental cost-effectiveness ratio (ICER) was thus €17,410 per QALY gained. A deterministic sensitivity analysis showed that hospitalisation rate and costs for telemonitoring equipment greatly affected results. The probabilistic ICER averaged €34,432 per QALY (95 % confidence interval 12,161-56,703). We provide evidence that telemonitoring may be cost-effective in Germany from a payer's point of view. This holds even after deterministic and probabilistic sensitivity analyses.

  13. Utility of mammaglobin and gross cystic disease fluid protein-15 (GCDFP-15) in confirming a breast origin for recurrent tumors.

    PubMed

    Chia, Shi Yun; Thike, Aye Aye; Cheok, Poh Yian; Tan, Puay Hoon

    2010-10-01

    There are limited data that compare the utility of immunohistochemical detection of mammaglobin with Gross Cystic Disease Fluid Protein-15 (GCDFP-15) in locally recurrent and metastatic breast cancers. Forty-three local and 72 distant recurrences of breast cancer, 8 metastatic lesions to the breast from other organs, and 30 metastases from non-breast primaries were immunohistochemically stained with mammaglobin and GCDFP-15 antibodies. Mammaglobin was expressed in 55 (47.8%) and GCDFP-15 detected in 13 (11.3%) locally and distantly recurrent breast cancers. A higher percentage of tumor cells was stained with mammaglobin at greater staining intensity than GCDFP-15, for both metastatic and locally recurrent breast cancers. The difference in staining intensity as well as mean percentage of tumor cells stained for both markers was statistically significant (p < 0.005). Metastases to the breast from other organs and metastatic lesions from non-breast primaries were uniformly negative for both mammaglobin and GCDFP-15. Our study demonstrates that immunohistochemical analysis of mammaglobin is superior to GCDFP-15 in detecting a tumor of breast origin, and can be incorporated into immunohistochemical panels evaluating tumors from unknown primary sites. Copyright © 2010 Elsevier Ltd. All rights reserved.

  14. An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease.

    PubMed

    Meyer, Keith C; Raghu, Ganesh; Baughman, Robert P; Brown, Kevin K; Costabel, Ulrich; du Bois, Roland M; Drent, Marjolein; Haslam, Patricia L; Kim, Dong Soon; Nagai, Sonoko; Rottoli, Paola; Saltini, Cesare; Selman, Moisés; Strange, Charlie; Wood, Brent

    2012-05-01

    The clinical utility of bronchoalveolar lavage fluid (BAL) cell analysis for the diagnosis and management of patients with interstitial lung disease (ILD) has been a subject of debate and controversy. The American Thoracic Society (ATS) sponsored a committee of international experts to examine all relevant literature on BAL in ILD and provide recommendations concerning the use of BAL in the diagnosis and management of patients with suspected ILD. To provide recommendations for (1) the performance and processing of BAL and (2) the interpretation of BAL nucleated immune cell patterns and other BAL characteristics in patients with suspected ILD. A pragmatic systematic review was performed to identify unique citations related to BAL in patients with ILD that were published between 1970 and 2006. The search was updated during the guideline development process to include published literature through March 2011. This is the evidence upon which the committee's conclusions and recommendations are based. Recommendations for the performance and processing of BAL, as well as the interpretation of BAL findings, were formulated by the committee. When used in conjunction with comprehensive clinical information and adequate thoracic imaging such as high-resolution computed tomography of the thorax, BAL cell patterns and other characteristics frequently provide useful information for the diagnostic evaluation of patients with suspected ILD.

  15. Utility of CD15, CD30 & CD45 in the immunohistochemical diagnosis of Hodgkin's disease by antigen retrieval method.

    PubMed

    Arici, D S; Aker, H; Güngör, M

    1999-01-01

    The utility of staining Reed-Sternberg (RS) cells with CD30, CD15 and CD45 as a diagnostic aid in Hodgkin's disease (HD) and the value of microwave citrate antigen retrieval (AR) method in improving the results of immunohistochemical (IHC) studies were evaluated. Histological and immunohistological studies were carried out on 21 patients with HD seen from January 1987 to December 1996 in the Pathology Department of the Cumhuriyet University, School of Medicine. Avidin biotin peroxidase complex (ABC) was used in IHC study as a method for detection of RS cells. Monoclonal antibodies CD30, CD15 and CD45 were applied on formalin fixed paraffin embedded tissue sections. In order to enhance the immunoreactivity, microwave citrate AR method and proteolytic pretreatment were used. The reactivity of RS cells and staining patterns were determined. In 14 (70%) of the 20 patients, RS cells stained positively with CD30, in 16 (80%) CD15 staining was positive and only 1 (5%) was positively stained with CD45. A combination of cytoplasmic with cell surface staining was common with CD30, while paranuclear deposit with cell surface and cytoplasmic staining was common with CD15. In conclusion, to facilitate the detection of RS cells in formalin fixed paraffin embedded tissues, the application of a panel of markers appears to be necessary. Also AR method seems to be helpful in obtaining optimal results on formalin fixed paraffin embedded tissue.

  16. Microimaging studies of myocardial substrate utilization and perfusion in two models of non-coronary heart disease

    SciTech Connect

    Som, P.; Oster, Z.H.; Knapp, F.F. Jr.

    1987-01-01

    We have studied two animal models of non-coronary heart disease. The salt-sensitive Dahl strain hypertensive rats and their genetically matched normotensive controls and the cardiomyopathic BIO 53.58 (CM) strain Syrian hamsters with age and sex-matched RB strain controls. The CM strain hamster seems to be a very good model of human congestive cardiomyopathy and the Dahl strain hypertensive rats have also been found to be good models for studying the effects of hypertension on the myocardium. In our studies we compared the utilization of various metabolic substrates, viz., fatty acids, glucose analogs, and the early distribution of /sup 201/Tl, as an indicator of myocardial flow. The routine studies involving dissection of animals for assaying the radioactivity following the injection of radiopharmaceuticals is not suitable for assessing regional changes in metabolism and flow. The use of quantitative autoradiographic microimaging (ARG) enables the visualization of discrete regional as well as global changes from normal and to quantitate them. This paper describes the methodology and results of these investigations. 14 refs., 5 figs.

  17. The neural substrates of memory systems impairment in Alzheimer's disease. A PET study of resting brain glucose utilization.

    PubMed

    Desgranges, B; Baron, J C; de la Sayette, V; Petit-Taboué, M C; Benali, K; Landeau, B; Lechevalier, B; Eustache, F

    1998-04-01

    The aim of this study was to determine the neuronal basis for memory impairment in Alzheimer's disease by taking advantage of the clinical and metabolic heterogeneity of this pathology. To this end, 19 patients satisfying the NINCDSADRDA criteria for probably Alzheimer's disease of mild-to-moderate severity underwent a detailed examination of the five memory systems according to Tulving's model, together with a PET measurement of resting regional cerebral glucose utilization (CMRGlc). Compared with controls, the patients as a group showed the expected memory and metabolic profiles of impairment. Correlations (corrected for the effects of ageing) were calculated between memory scores and CMRGlc (normalized by the vermis CMRGlc) using two methods: (i) the classic regions-of-interest method, based on a priori hypotheses and individual coregistered structural MRI; and (ii) the statistical parametric mapping method which allows a systematic voxel-by-voxel analysis, in a more descriptive and exploratory way. Significant correlations were above chance levels and largely consistent between the two methods. They were almost exclusively positive (i.e. in the neurobiologically expected direction) and their distribution showed striking differences according to each memory system. Thus, verbal episodic memory impairment was related to changes in a large neuronal network including not only the limbic structures (mesial temporal cortex, thalamus and cingulate gyrus, with left side predominance) but also the parietotemporal and frontal association cortices of the right hemisphere, possibly on a compensatory basis. Regardless of modality, short-term memory tests were mainly correlated with bilateral activity in posterior association cortex, and also with activity in left prefrontal cortex for the visuospatial span, possibly indicating essentially uniform strategies for the performance of the different tasks. As predicted, semantic memory scores correlated with activity in

  18. Prognostic utility of admission cell-free DNA levels in patients with chronic obstructive pulmonary disease exacerbations.

    PubMed

    Avriel, Avital; Rozenberg, Dmitry; Raviv, Yael; Heimer, Dov; Bar-Shai, Amir; Gavish, Rachel; Sheynin, Jony; Douvdevani, Amos

    2016-01-01

    Chronic obstructive pulmonary disease exacerbations (COPDEs) are associated with increased morbidity and mortality. Cell-free DNA (cfDNA) is a novel biomarker associated with clinical outcomes in several disease states but has not been studied in COPD. The objectives of this study were to assess cfDNA levels during a COPDE, to evaluate the association of cfDNA with clinical parameters and to explore the prognostic implications of cfDNA levels on long-term survival. This was an observational study that assessed cfDNA levels in patients admitted to hospital for a COPDE. Plasma cfDNA levels of COPDE patients were compared to those of matched stable COPD patients and healthy controls. Multivariable and Cox regression analyses were used to assess the association of cfDNA levels with blood gas parameters and long-term survival. A total of 62 patients (46 males, forced expiratory volume in 1 second [FEV1] 38%±13%) were included. The median cfDNA levels on admission for COPDE patients was 1,634 ng/mL (interquartile range [IQR] 1,016-2,319) compared to 781 ng/mL (IQR 523-855) for stable COPD patients, matched for age and disease severity, and 352 ng/mL (IQR 209-636) for healthy controls (P<0.0001, for both comparisons). cfDNA was correlated with partial arterial pressure of carbon dioxide (PaCO2, r=0.35) and pH (r=-0.35), P=0.01 for both comparisons. In a multivariable analysis, PaCO2 was the only independent predictor of cfDNA. Using a cfDNA level of 1,924 ng/mL (threshold for abnormal PaCO2), those with high levels had a trend for increased 5-year mortality risk adjusted for age, sex and FEV1% (hazard ratio 1.92, 95% confidence interval 0.93-3.95, P=0.08). Plasma cfDNA might offer a novel technique to identify COPD patients at increased risk of poor outcomes, but the prognostic utility of this measurement requires further study.

  19. Prognostic utility of admission cell-free DNA levels in patients with chronic obstructive pulmonary disease exacerbations

    PubMed Central

    Avriel, Avital; Rozenberg, Dmitry; Raviv, Yael; Heimer, Dov; Bar-Shai, Amir; Gavish, Rachel; Sheynin, Jony; Douvdevani, Amos

    2016-01-01

    Background Chronic obstructive pulmonary disease exacerbations (COPDEs) are associated with increased morbidity and mortality. Cell-free DNA (cfDNA) is a novel biomarker associated with clinical outcomes in several disease states but has not been studied in COPD. The objectives of this study were to assess cfDNA levels during a COPDE, to evaluate the association of cfDNA with clinical parameters and to explore the prognostic implications of cfDNA levels on long-term survival. Methods This was an observational study that assessed cfDNA levels in patients admitted to hospital for a COPDE. Plasma cfDNA levels of COPDE patients were compared to those of matched stable COPD patients and healthy controls. Multivariable and Cox regression analyses were used to assess the association of cfDNA levels with blood gas parameters and long-term survival. Results A total of 62 patients (46 males, forced expiratory volume in 1 second [FEV1] 38%±13%) were included. The median cfDNA levels on admission for COPDE patients was 1,634 ng/mL (interquartile range [IQR] 1,016–2,319) compared to 781 ng/mL (IQR 523–855) for stable COPD patients, matched for age and disease severity, and 352 ng/mL (IQR 209–636) for healthy controls (P<0.0001, for both comparisons). cfDNA was correlated with partial arterial pressure of carbon dioxide (PaCO2, r=0.35) and pH (r=−0.35), P=0.01 for both comparisons. In a multivariable analysis, PaCO2 was the only independent predictor of cfDNA. Using a cfDNA level of 1,924 ng/mL (threshold for abnormal PaCO2), those with high levels had a trend for increased 5-year mortality risk adjusted for age, sex and FEV1% (hazard ratio 1.92, 95% confidence interval 0.93–3.95, P=0.08). Conclusion Plasma cfDNA might offer a novel technique to identify COPD patients at increased risk of poor outcomes, but the prognostic utility of this measurement requires further study. PMID:28003743

  20. Advanced Communications Technology Satellite (ACTS)

    NASA Technical Reports Server (NTRS)

    Gedney, Richard T.; Schertler, Ronald J.

    1989-01-01

    The NASA Advanced Communications Technology Satellite (ACTS) was conceived to help maintain U.S. leadership in the world's communications-satellite market. This experimental satellite is expected to be launched by NASA in 1992 and to furnish the technology necessary for establishing very small aperture terminal digital networks which provide on-demand full-mesh connectivity, and 1.544-MBPS services with only a single hop. Utilizing on-board switching and processing, each individual voice or data circuit can be separately routed to any location in the network. This paper provides an overview of the ACTS and discusses the value of the technology for future communications systems.

  1. Satellite Earth resources data, module U-3

    NASA Technical Reports Server (NTRS)

    1980-01-01

    Satellite data image products potentially useful in solving Earth resource and environmental problems are described. Sources for satellite data and user information are given. Recommendations for suitability of use of data from each satellite are presented. Satellite sources of Earth resources data are summarized for satellites launched since 1965 and those projected for launch through the late 1980s. The sensors of interest on each satellite, the wavelength or frequency of operation, and the resolution are given. Color ranges are illustrated and compared. The form and utility of aircraft and LANDSAT images are compared. Data from the Gemini-Apollo photography, Skylab, meteorological satellites, the Heat Capacity Mapping Mission, the Coastal Zone Color Scanner, Seasat, LANDSAT, and projected future satellites are briefly described.

  2. Utility of A Satellite Vehicle For Reconnaissance.

    DTIC Science & Technology

    1951-04-01

    8217Cents& Oblique oblique frame$~ below Wowe.. sc h malic 01 to passing - ~ power9 th~rough 0011’s E ~nca r Sec enIA0onn, ~1 VOO 6 Escapldmle"’ ElectricO ...angular velocity around all three axes is much more important than any reasonable angular attitude error. Four small control motors are used during...optical-scanning system, circuitry 145 230* Transmitter and modulator 20 50 Tracking receiver and antenna control circuitry 10 30 Antenna and servo motors

  3. Gigabit Satellite Network for NASA's Advanced Communication Technology Satellite (ACTS)

    NASA Technical Reports Server (NTRS)

    Hoder, Douglas; Bergamo, Marcos

    1996-01-01

    The advanced communication technology satellite (ACTS) gigabit satellite network provides long-haul point-to-point and point-to-multipoint full-duplex SONET services over NASA's ACTS. at rates up to 622 Mbit/s (SONET OC-12), with signal quality comparable to that obtained with terrestrial fiber networks. Data multiplexing over the satellite is accomplished using time-division multiple access (TDMA) techniques coordinated with the switching and beam hopping facilities provided by ACTS. Transmissions through the satellite are protected with Reed-Solomon encoding. providing virtually error-free transmission under most weather conditions. Unique to the system are a TDMA frame structure and satellite synchronization mechanism that allow: (a) very efficient utilization of the satellite capacity: (b) over-the-satellite dosed-loop synchronization of the network in configurations with up to 64 ground stations: and (c) ground station initial acquisition without collisions with existing signalling or data traffic. The user interfaces are compatible with SONET standards, performing the function of conventional SONET multiplexers and. as such. can be: readily integrated with standard SONET fiber-based terrestrial networks. Management of the network is based upon the simple network management protocol (SNMP). and includes an over-the-satellite signalling network and backup terrestrial internet (IP-based) connectivity. A description of the ground stations is also included.

  4. Gigabit Satellite Network for NASA's Advanced Communication Technology Satellite (ACTS)

    NASA Technical Reports Server (NTRS)

    Hoder, Douglas; Bergamo, Marcos

    1996-01-01

    The advanced communication technology satellite (ACTS) gigabit satellite network provides long-haul point-to-point and point-to-multipoint full-duplex SONET services over NASA's ACTS. at rates up to 622 Mbit/s (SONET OC-12), with signal quality comparable to that obtained with terrestrial fiber networks. Data multiplexing over the satellite is accomplished using time-division multiple access (TDMA) techniques coordinated with the switching and beam hopping facilities provided by ACTS. Transmissions through the satellite are protected with Reed-Solomon encoding. providing virtually error-free transmission under most weather conditions. Unique to the system are a TDMA frame structure and satellite synchronization mechanism that allow: (a) very efficient utilization of the satellite capacity: (b) over-the-satellite dosed-loop synchronization of the network in configurations with up to 64 ground stations: and (c) ground station initial acquisition without collisions with existing signalling or data traffic. The user interfaces are compatible with SONET standards, performing the function of conventional SONET multiplexers and. as such. can be: readily integrated with standard SONET fiber-based terrestrial networks. Management of the network is based upon the simple network management protocol (SNMP). and includes an over-the-satellite signalling network and backup terrestrial internet (IP-based) connectivity. A description of the ground stations is also included.

  5. Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study.

    PubMed

    Montes de Oca, Maria; Aguirre, Carlos; Lopez Varela, Maria Victorina; Laucho-Contreras, Maria E; Casas, Alejandro; Surmont, Filip

    2016-01-01

    COPD, asthma, and asthma-COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma-COPD overlap. COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma-COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma-COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma-COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. COPD, asthma, and asthma-COPD overlap increase the prevalence of medical visits and, therefore, health care resource

  6. Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study

    PubMed Central

    Montes de Oca, Maria; Aguirre, Carlos; Lopez Varela, Maria Victorina; Laucho-Contreras, Maria E; Casas, Alejandro; Surmont, Filip

    2016-01-01

    Background COPD, asthma, and asthma–COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. Objectives To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma–COPD overlap. Methods COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma–COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. Results Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma–COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma–COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. Conclusion COPD, asthma, and asthma–COPD overlap increase the prevalence of

  7. Risk Factors for Nursing Home Placement in Alzheimer's Disease: A Longitudinal Study of Cognition, ADL, Service Utilization, and Cholinesterase Inhibitor Treatment

    ERIC Educational Resources Information Center

    Wattmo, Carina; Wallin, Asa K.; Londos, Elisabet; Minthon, Lennart

    2011-01-01

    Purpose of the Study: To identify risk factors for early nursing home placement (NHP) in Alzheimer's disease (AD), focusing on the impact of longitudinal change in cognition, activities of daily living (ADL), service utilization, and cholinesterase inhibitor treatment (ChEI). Design and Methods: In an open, 3-year, prospective, multicenter study…

  8. Risk Factors for Nursing Home Placement in Alzheimer's Disease: A Longitudinal Study of Cognition, ADL, Service Utilization, and Cholinesterase Inhibitor Treatment

    ERIC Educational Resources Information Center

    Wattmo, Carina; Wallin, Asa K.; Londos, Elisabet; Minthon, Lennart

    2011-01-01

    Purpose of the Study: To identify risk factors for early nursing home placement (NHP) in Alzheimer's disease (AD), focusing on the impact of longitudinal change in cognition, activities of daily living (ADL), service utilization, and cholinesterase inhibitor treatment (ChEI). Design and Methods: In an open, 3-year, prospective, multicenter study…

  9. A review of pediatric palliative care service utilization in children with a progressive neuromuscular disease who died on a palliative care program.

    PubMed

    Ho, Charles; Straatman, Lynn

    2013-01-01

    Recent studies and consensus statements have expressed the need to involve palliative care services in the care of children with progressive neuromuscular diseases (PMD), yet there have been no reviews of the utilization of palliative care services by children who died on a palliative care program. We conducted a retrospective chart review of all children who had a PMD who died on a single-center palliative care program. Twenty cases were identified. Services utilized by these patients included respite care, transition services, pain and symptom management, and end-of-life care. Prominent symptoms in the last 24 hours of life included respiratory distress, pain, nausea/vomiting, and anxiety; however, symptom management was very good. Utilization of services differed depending on the disease trajectory, with respite playing a critical role in the care of children with PMD. Good symptom management can be achieved.

  10. Continuation of the compendium of applications technology satellite and communications technology satellite user experiments 1967-1977, volume 2. [bibliography

    NASA Technical Reports Server (NTRS)

    Engler, N. A.; Nash, J. F.; Strange, J. D.

    1978-01-01

    Approximately 453 reports, papers, and articles catalogued into an information retrieval system, covering communications experiments and demonstrations conducted, utilizing the Communications Technology Satellite and the Applications Technology Satellites 1, 3, 5, and 6 are listed.

  11. Communication Technology Satellite Portable Terminal

    NASA Image and Video Library

    1977-03-21

    This vehicle served as a mobile terminal for the Communications Technology Satellite. The Communications Technology Satellite was an experimental communications satellite launched in January 1976 by the National Aeronautics and Space Administration (NASA) and the Canadian Department of Communications. The satellite operated in a new frequency band reserved for broadcast satellites with transmitting power levels that were 10 to 20 times higher than those of contemporary satellites. Throughout 1977 and 1978 NASA allowed qualified groups to utilize the satellite from one of the three ground-based transmission centers. NASA’s Lewis Research Center in Cleveland, Ohio was NASA’s lead center on the project. Lewis was responsible for the control and coordination of all US experiments on the satellite. The center housed the satellite’s main control center which included eight parabolic reflector antennae ranging from 2 to 15 feet in diameter. Many of the satellite’s components had been tested in simulated space conditions at Lewis. The Lewis-designed vehicle seen here served as a field unit for transmitting and receiving wideband signals and narrowband voice. The vehicle permitted live television interviews, recording equipment, and cameras. An 8-foot diameter parabolic reflector was mounted on the roof. The interior of the vehicle had workstations, monitors, transmitting equipment, and a lounge area.

  12. The impact of value-based healthcare for inflammatory bowel diseases on healthcare utilization: a pilot study.

    PubMed

    van Deen, Welmoed K; Spiro, Arlen; Burak Ozbay, A; Skup, Martha; Centeno, Adriana; Duran, Natalie E; Lacey, Precious N; Jatulis, Darius; Esrailian, Eric; van Oijen, Martijn G H; Hommes, Daniel W

    2017-03-01

    Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on