Research Interests: Cardiology, Carbon Dioxide, Medicine, Humans, Internal Medicine, and 15 moreHemodynamics, Blood Pressure, Female, Male, Acute Myocardial Infarction, Body Temperature, Aged, Middle Aged, Myocardial Infarction, Analysis of Variance, Indexation, Diuresis, Cardiogenic shock, Erythrocyte Count, and Cardiovascular medicine and haematology
Précis: We describe a method that provides rapid visualization of glaucomatous change in a 2-dimensional (2D) structural and functional (S/F) space. Purpose: To describe a method to visualize glaucomatous change in a 2D S/F space. Design:... more
Précis: We describe a method that provides rapid visualization of glaucomatous change in a 2-dimensional (2D) structural and functional (S/F) space. Purpose: To describe a method to visualize glaucomatous change in a 2D S/F space. Design: This was a retrospective longitudinal observational study. Subjects: Group I included 64 normal and 64 glaucomatous eyes used to develop the structural score. Group II included 957 glaucomatous eyes used to plot the structural-functional progression vectors. Methods: Subjects were arranged in 2 groups. Group I was a cross-sectional group used to develop a structural score which were applied to longitudinal measurements of patients in group II for vectoral analysis. Visual field index was used as a functional score. Vectors were created for each eye to define structural (x) and functional (y) progression. The structural and functional components were calculated with linear models of optical coherence tomography scores and visual field index. The resultant vector and its confidence interval were plotted in 2D S/F space. Main Outcome Measures: Combined structural-functional glaucomatous progression. Results: Group I included 64 normal and 64 glaucomatous eyes. We calculated 957 vectors (957 eyes of 582 OAG patients) in group II. The mean (±SD) follow-up period was 6.9 (±1.5) years and mean baseline mean deviation (MD) was −4.3 (±5.4). Preperimetric, mild, moderate, and severe groups included 159, 288, 299, and 211 eyes, respectively. Mean baseline MDs in these groups were 0.8, −1.0, −3.7, and −11.2 dB, and mean vector slopes were 0.88, 1.00, 1.98, and 2.69. Conclusion: We present a method that presents glaucoma progression in a 2D S/F space. This approach integrates a large amount of longitudinal numerical data and provides the clinician with a rapid and intuitive summary of the patient’s glaucoma trajectory.
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Research Interests: Mathematics, Nursing, Medicine, Trauma, Methods, and 4 moreHumans, Clinical Sciences, Cardiac output, and Dilution
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Quantitative assessment of the severity of illness and prognosis of critically ill patients provides a basis for objective evaluation of selective aspects of patient care. In studies on patients with acute myocardial infarction and shock,... more
Quantitative assessment of the severity of illness and prognosis of critically ill patients provides a basis for objective evaluation of selective aspects of patient care. In studies on patients with acute myocardial infarction and shock, linear combinations of cardiac index and lactate were most reliable for estimating severity of illness and prognosis (1). When patients with shock due to drug overdose were analyzed, two different variables emerged as the most reliable indicators, systolic pressure and arterial pH (2). The present study was undertaken to identify the most useful hemodynamic, respiratory and metabolic variables for assessing the severity of illness in patients with shock due to gram-negative bacterial infection. Prognostic indices based on combinations of these variables were derived. The effect of the time of the measurements also was evaluated to determine its influence on the reliability of the prognosis.
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PURPOSE To identify predictive factors for visual field (VF) fluctuation in glaucoma patients. DESIGN Retrospective cohort study. PARTICIPANTS A total of 1392 eyes (816 patients) with 6 or more VFs and 3 years or more of follow-up.... more
PURPOSE To identify predictive factors for visual field (VF) fluctuation in glaucoma patients. DESIGN Retrospective cohort study. PARTICIPANTS A total of 1392 eyes (816 patients) with 6 or more VFs and 3 years or more of follow-up. METHODS For each eye, the VF mean deviation (MD) and the pointwise sensitivities were regressed against time to model the series trend, and the root mean square error (RMSE) was estimated as a measure of variability. Potential predictors were selected with least absolute shrinkage and selection operator regression and included eye laterality, ethnicity, glaucoma type, intraocular pressure (IOP) fluctuation, baseline best corrected-visual acuity, intervening cataract or glaucoma surgery, length of follow-up, frequency of testing, baseline MD, rates of VF progression, and median false positive (FP) and false negative (FN) responses. MAIN OUTCOME MEASURES Predictors of global and pointwise VF long-term fluctuation. RESULTS In the global model, left eye (0.063 dB; P = 0.022), Asian descent (0.265 dB; P = 0.006), larger IOP fluctuation (0.051 dB; P < 0.001), intervening cataract surgery (0.090 dB; P = 0.023), longer follow-up (0.130 dB; P < 0.001), worse baseline MD (-0.145 dB; P < 0.001), faster VF decay rate (-0.090 dB; P < 0.001), and higher FP rate (0.145 dB; P < 0.001) and FN rate (0.220 dB; P < 0.001) were predictors of VF fluctuation. In the pointwise model, larger IOP fluctuation (0.039 dB; P = 0.022), longer follow-up (0.340 dB; P < 0.001), higher VF frequency (0.238 dB; P = 0.002), intervening glaucoma surgery (0.190 dB; P = 0.01), worse baseline MD (-0.535 dB; P < 0.001), faster VF decay rate (-0.340 dB; P < 0.001), and higher FP rate (0.255 dB; P < 0.001) and FN rate (0.395 dB; P < 0.001) were associated with increased fluctuation. The multivariable model explained 57% and 28% of the pointwise and global variances, respectively. CONCLUSIONS This study identified novel predictors of VF fluctuation, and explains nearly 60% of the pointwise variance. In the presence of factors predictive of high fluctuation, increased frequency of testing and better analytics will help to identify VF progression more accurately.
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PURPOSE To present a method that allows visualization of functional and structural change in 2-dimensional space. DESIGN Retrospective, longitudinal, observational study. PARTICIPANTS Patients from the Stein Eye Institute, UCLA from 1993... more
PURPOSE To present a method that allows visualization of functional and structural change in 2-dimensional space. DESIGN Retrospective, longitudinal, observational study. PARTICIPANTS Patients from the Stein Eye Institute, UCLA from 1993 through 2017. METHODS Patients were arranged into 2 cohorts. Cohort 1 was used to create a structural score for the horizontal axis of the structural-functional (S-F) 2-dimensional space. The visual field (VF) index was used for the vertical axis as the functional score. Cohort 2 was used to apply those scores for analysis of S-F progression with a combined vector. The first cohort included eyes with mild glaucoma (abnormal glaucoma hemifield test results, pattern standard deviation <0.05 on 2 examinations, or mean deviation [MD] >-5 dB) and normal control participants. The second cohort included all stages of open-angle glaucoma with ≥5 OCT retinal nerve fiber layer scans, ≥5 reliable visual field (VF) results, and follow-up of ≥4 years. MAIN OUTCOME MEASURES Vectors were created for each eye to represent the trajectory of glaucoma progression over time. Each vector was defined by structural (x-axis) and functional (y-axis) components. The structural component was calculated with a linear model of Heidelberg Retina Tomograph (Heidelberg Engineering, Heidelberg, Germany) scores over time. The functional component was calculated with a linear model of VF measurements over time. The resultant vector and its confidence interval were plotted in 2-dimensional S-F space. Eyes were divided into severity stages based on baseline MD. A mean vector was calculated for each severity stage. RESULTS We obtained 290 vectors from 290 eyes of 196 patients. The mean ± standard deviation follow-up period was 14.6±3.1 years. Average age was 58.6±8.8 years. Preperimetric, mild, moderate, and severe categories included 41, 89, 97, and 63 eyes, respectively. Mean baseline MDs were 0.8 dB, -0.95 dB, -3.57 dB, and -11.51 dB, respectively, and mean vector slopes for each severity categories were 0.79, 0.95, 1.95, and 2.08, respectively. Cook's distance removed 131 (7.1%) and 137 (7.4%) outliers from the structure and function regressions, respectively. CONCLUSIONS We report a method to visualize the trajectory of a patient's glaucoma progression in a 2-dimensional S-F space. The slope of the trajectory of glaucoma progression is a function of the severity of the disease.
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The aim of this research was to evaluate the economic impact of a collaborative nurse practitioner (NP) care management model on the use of pharmaceutical resources, with a focus on antibiotics, among general medicine inpatients. Although... more
The aim of this research was to evaluate the economic impact of a collaborative nurse practitioner (NP) care management model on the use of pharmaceutical resources, with a focus on antibiotics, among general medicine inpatients. Although studies have shown the effectiveness of care management by NPs, especially as reflected on length of stay and hospital cost, little is known about their impact on drug cost. The researchers utilized pharmaceutical claims data of 1,200 subjects who participated in the Multidisciplinary, Physician, and Nurse Practitioner Study from 2000 to 2004 to assess the effect of the NP-led care management model on drug utilization outcomes. Study findings revealed that the intervention group was associated with significant reduction in drug cost and drug utilization; even though the intervention group was more likely to be given broad-spectrum or other antibiotics, its overall drug and antibiotic costs were lower than the control group. Drug management strategies such as de-escalation and intravenous-to-oral conversion facilitated by NPs may potentially produce both clinically and economically advantageous outcomes among general medicine inpatients.
Research Interests: Nursing, Adolescent, Medicine, Applied Economics, Linear models, and 15 moreMultivariate Analysis, Drug, Humans, Female, Male, Aged, Middle Aged, Nurse Practitioners, Adult, Drug Costs, Cost Control, Multidisciplinary Approach, Nursing Economics, Drug utilization review, and Outcome Assessment Health Care
Page 1. EFFECTS OF SHORT-TERM, SINGLE AND COMBINED EXPOSURE.OF RATS TO NO, AND 0, ON LUNG TISSUE ENZYME ACTIVITIES long-Song lee Department of Environmental Health Sciences, School of Public ...
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To examine the pulmonary effects of relatively low levels of NO2 and O3, and test for any possible interaction in their effects, we exposed 3-mo-old male Sprague-Dawley rats, free of specific pathogens, to either filtered room air... more
To examine the pulmonary effects of relatively low levels of NO2 and O3, and test for any possible interaction in their effects, we exposed 3-mo-old male Sprague-Dawley rats, free of specific pathogens, to either filtered room air (control) or 1.20 ppm (2256 micrograms/m3) NO2, 0.30 ppm (588 micrograms/m3) O3, or a combination of the two oxidants continuously for 3 d. We studied a series of parameters in the lung, including lung weight, and enzyme activities related to NADPH generation, sulfhydryl metabolism, and cellular detoxification. The results showed that relative to control, exposure to NO2 caused small but nonsignificant changes in all the parameters; O3 caused significant increases in all the parameters except for superoxide dismutase; and a combination of NO2 and O3 caused increases in all the parameters, and the increases were greater than those caused by NO2 or O3 alone. Statistical analysis of the data showed that the effects of combined exposure were synergistic for 6-phosphogluconate dehydrogenase, isocitrate dehydrogenase, glutathione reductase, and superoxide dismutase activities, and additive for glutathione peroxidase and disulfide reductase activities, but indifferent from those of O3 exposure for other enzyme activities.
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In this chapter, we will tell the story of how the Pipeline, Profession, and Practice: Community-Based Dental Education program affected the recruitment and retention of underrepresented minority (URM) dental students, beginning with how... more
In this chapter, we will tell the story of how the Pipeline, Profession, and Practice: Community-Based Dental Education program affected the recruitment and retention of underrepresented minority (URM) dental students, beginning with how these students decide on dentistry as a career. We will then
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In this paper we review the literature on the problem of handling multivariate data with observations missing on some or all of the variables under study. We examine the ways that statisticians have devised to estimate means, variances,... more
In this paper we review the literature on the problem of handling multivariate data with observations missing on some or all of the variables under study. We examine the ways that statisticians have devised to estimate means, variances, correlations and linear regression functions from such data and refer to specific computer programs for carrying out the estimation. We show how
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Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent and little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the... more
Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent and little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the effectiveness of programs to assist people with HIV/AIDS in their efforts to return to work. We used logistic regression and Kaplan-Meier survival curves to predict return to work using data from 126 individuals who participated in an HIV/AIDS return to work program. Results from the 24 month follow-up revealed that program participation, general health, benefits status, and gender, predicted successful re-entry to the workforce. We discuss these findings in the context of the need for more explicitly-defined interventions, as well as the need for additional information on factors that may hinder or facilitate workforce re-entry among people with HIV/AIDS.
Research Interests: Mechanical Engineering, Program Evaluation, Psychology, Employment, Medicine, and 15 moreLogistic Regression, California, Humans, Work, Female, Pubmed, Male, Psychological Intervention, Workforce, Middle Aged, Questionnaires, Adult, Public health systems and services research, Hiv seropositivity, and Guidance and Counseling Intervention Programs
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Objective: To assess the knowledge, attitude and behaviour regarding AIDS among educated young people in Lahore, Pakistan. Methods: An anonymous survey of 733 males and 355 females was carried out using structured questionnaire among... more
Objective: To assess the knowledge, attitude and behaviour regarding AIDS among educated young people in Lahore, Pakistan. Methods: An anonymous survey of 733 males and 355 females was carried out using structured questionnaire among educated youth, selected randomly from non-medical educational institutions and work places. Results: Knowledge on exsistance of AIDS in Pakistan was expressed by 698 (95.2%) males and 273 (76.9%) females, in, while only 189 (25.7%) males and 76 (21.4%) females knew its cause. Knowledge of the different modes of transmission was good, however 59%, 48%, 68% and 43% males; 28%, 45%, 59% and 35% females believed that it could be transmitted through sharing of utensils, mouth kissing, casual contact and mosquito bite, respectively. Ninety one percent males and 86% females believed that AIDS sufferers should be isolated. Extra marital sex was experienced by 6% subjects and only 5% used condoms. Generally, males had better knowledge than females except in attitudes towards monogamy and having sex with someone known. Conclusions: The study revealed gaps in the knowledge of females regarding AIDS and its transmission. The results indicates an urgent need to include health education syllabi emphasising AIDS and other Sexually Transmitted Diseases in the Curriculum of schools/colleges to convey the message adequately to the youth.
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We compare six methods for constructing confidence intervals for a single parameter in stratified logistic regression. Three of these are based on inversion of standard asymptotic tests--namely, the Wald, the score, and the likelihood... more
We compare six methods for constructing confidence intervals for a single parameter in stratified logistic regression. Three of these are based on inversion of standard asymptotic tests--namely, the Wald, the score, and the likelihood ratio tests. The other three are based on the exact distribution of the sufficient statistic for the parameter of interest. These include the traditional exact method of constructing confidence intervals, and two others, the mid-P and mean-P methods, which are modifications of this procedure that aim at reducing the conservative bias of the exact method. Using efficient algorithms, the six methods are compared by determination of their exact coverage levels in a series of conditional sample spaces. An incident case-control study of lung cancer in women is used to further illustrate the differences among the various methods. Computation of coverage functions is seen as a useful graphical diagnostic tool for assessing the appropriateness of different methods. The mid-P and the score methods are seen to have better coverage properties than the other four.
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Objective measurements of hemodynamic, respiratory and metabolic variables have assumed an increasingly important role in the management of patients in shock. Such measurements have facilitated the physician's understanding of the... more
Objective measurements of hemodynamic, respiratory and metabolic variables have assumed an increasingly important role in the management of patients in shock. Such measurements have facilitated the physician's understanding of the mechanisms ...