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Douglas W Mapel,1,* Melissa H Roberts,1,* Susan Sama,2 Priyanka J Bobbili,3 Wendy Y Cheng,3 Mei Sheng Duh,3 Catherine Nguyen,3 Philippe Thompson-Leduc,3 Melissa K Van Dyke,4 Kieran J Rothnie,4 Devi Sundaresan,2 Julia M Certa,5 Thomas S Whiting,5 Jennifer L Brown,5 Douglas W Roblin5 1College of Pharmacy, University of New Mexico, Albuquerque, NM, USA; 2Reliant Medical Group, Inc., Worcester, MA, USA; 3Analysis Group, Inc., Boston, MA, USA; 4GlaxoSmithKline plc., London, UK; 5Kaiser Permanente Mid-Atlantic States (KPMAS), Mid-Atlantic Permanente Research Institute (MAPRI), Rockville, MD, USA*These authors contributed equally to this workCorrespondence: Melissa H RobertsCollege of Pharmacy, University of New Mexico, 2502 Marble Ave, Albuquerque, NM, 87106, USATel +1 505 925-0953Email MHRoberts@salud.unm.eduIntroduction: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important events that may precipitate other adverse outcomes. Accurate AECOPD event identification in electronic administrative data is essential for improving population health surveillance and practice management.Objective: Develop codified algorithms to identify moderate and severe AECOPD in two US healthcare systems using administrative data and electronic medical records, and validate their performance by calculating positive predictive value (PPV) and negative predictive value (NPV).Methods: Data from two large regional integrated health systems were used. Eligible patients were identified using International Classification of Diseases (Ninth Edition) COPD diagnosis codes. Two algorithms were developed: one to identify potential moderate AECOPD by selecting outpatient/emergency visits associated with AECOPD-related codes and antibiotic/systemic steroid prescriptions; the other to identify potential severe AECOPD by selecting inpatient visits associated with corresponding codes. Algorithms were validated via patient chart review, adjudicated by a pulmonologist. To estimate PPV, 300 potential moderate AECOPD and 250 potential severe AECOPD events underwent review. To estimate NPV, 200 patients without any AECOPD identified by the algorithms (100 patients each without moderate or severe AECOPD) during the two years following the index date underwent review to identify AECOPD missed by the algorithm (false negatives).Results: The PPVs (95% confidence interval [CI]) for both moderate and severe AECOPD were high: 293/298 (98.3% [96.1– 99.5]) and 216/225 (96.0% [92.5– 98.2]), respectively. NPV was lower for moderate AECOPD (75.0% [65.3– 83.1]) than for severe AECOPD (95.0% [88.7– 98.4]). Results were consistent across both healthcare systems.Conclusion: This study developed healthcare utilization-based algorithms to identify moderate and severe AECOPD in two separate healthcare systems. PPV for both algorithms was high; NPV was lower for the moderate algorithm. Replication and consistency of results across two healthcare systems support the external validity of these findings.Keywords: claims database, algorithm, validation, electronic medical records, predictive values, AECOPD events

Here, we explored the rate of telomere attrition with increasing age by real-time quantitative PCR (qPCR) in a short- (Chihuahua dog) and long- (Asian elephant) lived species. A total of 122 Asian elephants (female = 106, male = 16) ranging from 24-840 months of age, and 89 Chihuahuas (female = 65, male = 24) 1-179 months of age were used in this study. We found that young (pre- and peri-pubertal) Asian elephants had a higher relative telomere length (RTL) compared to dogs. A low, but significant negative relationship between RTL and increasing age was observed in both Chihuahuas (R2 =0.0490, P=0.0017) and Asian elephants (R2 =0.0177, P=0.0210). The estimated rate of telomere loss for males and females of both species ranged from -0.0023 to -0.0065, with no clear differences between gender or species. Results suggest that Asian elephants may start with longer telomeres than Chihuahuas, as RTL was higher, but then the rate of telomere attrition proceeds at a similar rate in both species. Age accounted for only a small percentage of the variation in RTL in both Chihuahua dogs and Asian elephants, however. Thus, its use as a biological tool for age estimation would appear to be limited for these species.

Jeffrey L Brown1,2 1Department of Pediatrics, New York Medical College, 2Departments of Pediatrics and Psychiatry, Weill Cornell Medical College, NY, USA Background: An unofficial standardized “write-up” outline is commonly used for documenting history and physical examinations, giving oral presentations, and teaching clinical skills. Despite general acceptance, there is an apparent discrepancy between the way clinical encounters are conducted and how they are documented.Methods: Fifteen medical school websites were randomly selected from search-engine generated lists. One example of a history and physical write-up from each of six sites, one teaching outline from each of nine additional sites, and recommendations for documentation made in two commonly used textbooks were compared for similarities and differences.Results: Except for minor variations in documenting background information, all sampled materials utilized the same standardized format. When the examiners’ early perceptions of the patients’ degree of illness or level of distress were described, they were categorized as “general appearance” within the physical findings. Contrary to clinical practice, none of the examples or recommendations documented these early perceptions before chief concerns and history were presented.Discussion: An examiner’s initial perceptions of a patient’s affect, degree of illness, and level of distress can influence the content of the history, triage decisions, and prioritization of likely diagnoses. When chief concerns and history are shared without benefit of this information, erroneous assumptions and miscommunications can result.Conclusion: This survey confirms common use of a standardized outline for documenting, communicating, and teaching history-taking and physical examination protocol. The present outline shares early observations out of clinical sequence and may provide inadequate context for accurate interpretation of chief concerns and history. Corrective actions include modifying the documentation sequence to conform to clinical practice and teaching contextual methodology for sharing patient information. Keywords: documentation, medical errors, medical history, medical decisions, initial assessment, write-up, physical examination, communication, context, communication

We have measured the mass of the Z boson to be 91.110.23 GeV/c2, and its width to be 1.61-0.43+0.60 GeV. If we constrain the visible width to its standard-model value, we find the partial width to invisible decay modes to be 0.620.23 GeV, corresponding to 3.81.4 neutrino species. © 1989 The American Physical Society.

PURPOSE: To evaluate the test-retest reliability of self-reported sexuality-related data in a sample of African American adolescents residing in four U.S. cities. METHODS: Using audio computer-assisted self-interviewing (ACASI), 156 African American teens (mean age = 15.5 years) provided data on lifetime and recent sexual behavior, HIV/sexually transmitted disease (STD) testing, and theoretical antecedents of sexual risk behavior on two occasions separated by 2 weeks. RESULTS: Most self-reports of lifetime sexual behavior and STD/HIV testing were stable across the two assessment points. Test-retest agreement was substantial for dichotomous indices of lifetime sexual behaviors and STD testing (kappas ranging from .61-.87), and for 3-month recall of vaginal sex (kappa = .72) and number of sexual partners (intraclass correlation coefficient [ICC] = .68). Lower reliability estimates emerged for count data of unprotected vaginal sex occasions (ICC = .44). Test-retest reliability estimates for antecedents of sexual risk behavior were highest for a validated measure of HIV-related knowledge (r = .73), but somewhat lower for peer norms (r = .58) and condom use self-efficacy (r = .50). CONCLUSIONS: Although variability in the stability of self-report data was observed, findings confirm that most sexual behavior, STD and HIV testing history, and psychosocial measures can be assessed reliably among adolescents. Research should continue to identify strategies to enhance the reliability of self-report sexual behavior data from youth at risk for HIV and other sexually transmitted infections. [ABSTRACT FROM AUTHOR]

To determine if tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6). IL-6 gene expression is influenced by amount and source of dietary fat, 30 weanling female rats were randomly assigned to a moderate-fat soybean oil (MFS; 22% of total energy fed as fat), high-fat (HF) soybean oil (HFS; 39% of total energy fed as fat), or HF tallow (HFT; 39% of total energy fed as fat) diet treatments. Oral glucose tolerance tests (OGTT) were conducted serially over 10 weeks of treatment. HFT and HFS rats gained more weight and had greater body fat than the MFS rats fed similar amounts of energy. Both groups of HF-fed rats had greater (P<.05) insulin resistance (homeostasis model assessment) than MFS-fed rats. TNF-alpha mRNA abundance quantified by real-time reverse transcriptase-polymerase chain reaction was greater (P<.05) in liver and lower (P<.05) in adipose tissue in HFT compared to HFS and MFS rats. There were positive correlations (P<.05) between hepatic TNF-alpha mRNA and insulin resistance, and negative correlations between insulin sensitivity and hepatic TNF-alpha mRNA and hepatic IL-6 mRNA. During Week 3 and Week 6 OGTTs, hyperinsulinemic responses were observed in the HFT group, after which, on Week 9, insulin secretion was diminished in response to the OGTT, suggesting impaired pancreatic insulin secretion. HFS rats exhibited insulin resistance on Week 9 OGTT. In summary, an HFT diet fed to growing female rats caused insulin resistance associated with increased hepatic TNF-alpha mRNA leading to pancreatic insufficiency. Early-onset insulin resistance related to the inflammatory process in obesity is influenced by the amount and type of fat in the diet. [ABSTRACT FROM AUTHOR]

Background: Psychological adjustment and coping are central to human immunodeficiency virus (HIV) management. To improve HIV-infected patients' ability to cope with stress, a variety of stress management interventions have been designed and evaluated.Purpose: This paper provides a review and critique of the stress management literature, including a: (1) synthesis of core components of interventions for HIV-infected people, (2) summary of stress, coping, psychological, and health outcomes, and (3) methodological critique and guidance for future research.Methods: We reviewed 21 stress management interventions designed for HIV-infected individuals that included both cognitive and behavioral skills training.Results: Most studies noted positive changes in perceived stress, depression, anxiety, global psychological functioning, social support, and quality of life. However, results were mixed for coping and health status outcomes, and a majority of studies employed only brief follow-up periods, focused on HIV-infected MSM, and did not address HIV-specific stressors.Conclusions: Stress management interventions for HIV-infected persons are a promising approach to facilitate positive adjustment. However, this literature is limited by measurement problems, research design features, a narrow focus on HIV-infected men who have sex with men, and feasibility concerns for intervention dissemination. Future stress management interventions should address these limitations and the unique psychosocial needs of HIV-infected patients using briefer, more cost-effective formats. [ABSTRACT FROM AUTHOR]

Factors influencing Chinese Americans' dairy consumption were determined from 8 focus groups, stratified by marital status and sex, and conducted with a script based on the theory of planned behavior. Participants ate only 1.5 +/- 1.1 servings of dairy daily. Their consumption was influenced by taste and convenience (personal attitudes), preferences and advice of family members and friends (subjective norm), and many barriers (perceived behavioral control). Dairy products preferred fit into breakfast or snacks, or were ingredients in fast foods. Participants lacked ability to cook with dairy products to different degrees. Barriers to consumption included traditional dietary habits, unfamiliarity with many dairy products, high price, and unacceptable taste and fat content. Strategies to address these findings are suggested. [ABSTRACT FROM AUTHOR]

In 2003, 6.0% of elderly households experienced food insecurity because of lack of resources; 1.7% of elderly households experienced the most severe form of food insecurity-hunger. Elderly households that have low income, are minority, are socially isolated, or have physical or mental impairments are at higher risk for food insecurity and hunger. Food insecurity and hunger among elders contribute to malnutrition, which can exacerbate disease, increase disability, decrease resistance to infections, and extend hospitals stays. Utilizing federal nutrition programs, eating with others, and getting regular medical checkups are a few of the ways to reduce food insecurity among elders. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore how couples adjust to dietary management of type 2 diabetes. DESIGN: Couples were interviewed, first together and then separately, during the first year after diagnosis and 1 year later. SETTING: Qualitative interviews conducted in hospital classrooms using a semistructured interview guide. PARTICIPANTS: Couples (N = 20) with a recently diagnosed spouse who met the study criteria were purposefully selected from volunteers solicited from hospital-based diabetes classes. PHENOMENON OF INTEREST: Processes used by the couple to address the prescribed diet. ANALYSIS: Thematic analysis of interview transcripts using grounded theory to identify patterns of adaptation processes used over time. RESULTS: Three couple categories emerged (cohesive, enmeshed, and disengaged), representing adaptation to the diabetic diet. Initially, 5 couples were cohesive (teamwork approach), 7 were enmeshed (nondiabetic spouse responsible for the diet; spouse was dependent), and 8 were disengaged (spouses functionally separate; spouse was solely responsible for the diet management). A year later, the majority of couples were disengaged (n = 14), 1 couple remained cohesive, and 4 couples remained enmeshed. Themes of flexibility, roles, rules, and communication varied across categories. CONCLUSIONS AND IMPLICATIONS: Understanding categories of marital adjustment to the diabetic diet may improve nutrition-based diabetes interventions. Further study is needed to verify these findings in larger and more diverse populations. [ABSTRACT FROM AUTHOR]

The pain undeniably exists in many children, but that it has anything to do with growth is questionable. This common enigma needs a close look to avoid missing something more serious. [ABSTRACT FROM AUTHOR]