Cost calculation and prediction in adult intensive care: A ground-up utilization study

Publisher's copy made available with the permission of the publisherThe ability of various proxy cost measures, including therapeutic activity scores (TISS and Omega) and cumulative daily severity of illness scores, to predict individual ICU patient costs was assessed in a prospective “ground-up” utilization costing study over a six month period in 1991. Daily activity (TISS and Omega scores) and utilization in consecutive admissions to three adult university associated ICUs was recorded by dedicated data collectors. Cost prediction used linear regression with determination (80%) and validation (20%) data sets. The cohort, 1333 patients, had a mean (SD) age 57.5 (19.4) years, (41% female) and admission APACHE III score of 58 (27). ICU length of stay and mortality were 3.9 (6.1) days and 17.6% respectively. Mean total TISS and Omega scores were 117 (157) and 72 (113) respectively. Mean patient costs per ICU episode (1991 $AUS) were$6801 ($10311), with median costs of$2534, range $106 to$95,602. Dominant cost fractions were nursing 43.3% and overheads 16.9%. Inflation adjusted year 2002 (mean) costs were $9343 ($ AUS). Total costs in survivors were predicted by Omega score, summed APACHE III score and ICU length of stay; determination R2, 0.91; validation 0.88. Omega was the preferred activity score. Without the Omega score, predictors were age, summed APACHE III score and ICU length of stay; determination R2, 0.73; validation 0.73. In non-survivors, predictors were age and ICU length of stay (plus interaction), and Omega score (determination R2, 0.97; validation 0.91). Patient costs may be predicted by a combination of ICU activity indices and severity scores.J. L. Moran, A. R. Peisach, P. J. Solomon, J. Martinhttp://www.aaic.net.au/Article.asp?D=200403

Meta-analysis of type 2 Diabetes in African Americans Consortium

Type 2 diabetes (T2D) is more prevalent in African Americans than in Europeans. However, little is known about the genetic risk in African Americans despite the recent identification of more than 70 T2D loci primarily by genome-wide association studies (GWAS) in individuals of European ancestry. In order to investigate the genetic architecture of T2D in African Americans, the MEta-analysis of type 2 DIabetes in African Americans (MEDIA) Consortium examined 17 GWAS on T2D comprising 8,284 cases and 15,543 controls in African Americans in stage 1 analysis. Single nucleotide polymorphisms (SNPs) association analysis was conducted in each study under the additive model after adjustment for age, sex, study site, and principal components. Meta-analysis of approximately 2.6 million genotyped and imputed SNPs in all studies was conducted using an inverse variance-weighted fixed effect model. Replications were performed to follow up 21 loci in up to 6,061 cases and 5,483 controls in African Americans, and 8,130 cases and 38,987 controls of European ancestry. We identified three known loci (TCF7L2, HMGA2 and KCNQ1) and two novel loci (HLA-B and INS-IGF2) at genome-wide significance (4.15 × 10(-94)<P<5 × 10(-8), odds ratio (OR)  = 1.09 to 1.36). Fine-mapping revealed that 88 of 158 previously identified T2D or glucose homeostasis loci demonstrated nominal to highly significant association (2.2 × 10(-23) < locus-wide P<0.05). These novel and previously identified loci yielded a sibling relative risk of 1.19, explaining 17.5% of the phenotypic variance of T2D on the liability scale in African Americans. Overall, this study identified two novel susceptibility loci for T2D in African Americans. A substantial number of previously reported loci are transferable to African Americans after accounting for linkage disequilibrium, enabling fine mapping of causal variants in trans-ethnic meta-analysis studies.Peer reviewe

Track A Basic Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138319/1/jia218438.pd

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Losses and transport of odd nitrogen species over the Western Atlantic Ocean during CASE/WATOX

Aircraft and shipboard measurements of mixing ratios for odd nitrogen species (N0y) were made over the western Atlantic Ocean during the summer of 1988. N0y in boundary layer air ranged from 4.8 ppbv near the U.S. east coast to 1.7 ppbv near a research ship 160 km from the coast. A vertical N0y gradient was observed near shore; mixing ratios decreased with altitude from 3.0 ppbv at 150 m to 1.3 ppbv at 2600 m. A smaller N0y gradient was observed near the ship, with mixing ratios also decreasing with altitude. During the observation period of this experiment, a high-pressure system over the mid-Atlantic limited advection of polluted continental air to a band just along the coast, thus preserving less polluted conditions to the east of the band. Loss rates for N0y advected from the continent, based on 3 eastward flights from the U.S. east coast, were estimated to be 2.0 ± 1.5% hour−1. Measurements near Bermuda were in marine air with average mixing ratios near the surface of 0.8 ppbv for NOy and 0.3 ppbv for total NO3 −. No significant vertical gradient was observed for NOy near Bermuda, where the high-altitude N0y mixing ratio was 0.7 ppbv. Overall, N0y mixing ratios near Bermuda were higher than would be expected on the basis of either measurements or computer modeling for remote marine air, suggesting possible influence from local anthropogenic sources

Inorganic nitrogen over the Western North Atlantic Ocean

The concentrations of the reactive nitrogen species NO2, NOx(= NO + NO2), NOy (the sum of all compounds of nitrogen and oxygen with the exception of N2O), particulate NO3 −, and volatile NO3 − were measured from ship and aircraft platforms over the western North Atlantic Ocean as part of the GCE/CASE/WATOX experiment. Air masses sampled were divided into continentally influenced and typical marine on the basis of trajectories, and radon and black carbon measurements. From the NO3 − measurements on size separated aerosol and the altitude variations of volatile NO3 − and particulate NO3 −, a significant interaction between volatile NO3 − and sea salt aerosol was indicated. The average marine concentrations measured were: 18 nmol m−3 for NO2, 29 nmol m−3 for NOx, 46 nmol m−3 for NOy, and 10 nmol m−3 for total inorganic NO3 −. The reactive nitrogen species were present at concentrations some 40 times those encountered in the remote Pacific Ocean, whereas the inorganic NO3 − was only 3 times higher