Implications of the problem orientated medical record (POMR) for research using electronic GP databases: a comparison of the Doctors Independent Network Database (DIN) and the General Practice Research Database (GPRD).

Background The General Practice Research Database (GPRD) and Doctor's Independent Network Database (DIN), are large electronic primary care databases compiled in the UK during the 1990s. They provide a valuable resource for epidemiological and health services research. GPRD (based on VAMP) presents notes as a series of discrete episodes, whereas DIN is based on a system (MEDITEL) that used a Problem Orientated Medical Record (POMR) which links prescriptions to diagnostic problems. We have examined the implications for research of these different underlying philosophies. Methods Records of 40,183 children from 141 practices in DIN and 76,310 from 464 practices in GRPD who were followed to age 5 were used to compare the volume of recording of prescribing and diagnostic codes in the two databases. To assess the importance and additional value of the POMR within DIN, the appropriateness of diagnostic linking to skin emollient prescriptions was investigated. Results Variation between practices for both the number of days on which prescriptions were issued and diagnoses were recorded was marked in both databases. Mean number of "prescription days" during the first 5 years of life was similar in DIN (19.5) and in GPRD (19.8), but the average number of "diagnostic days" was lower in DIN (15.8) than in GPRD (22.9). Adjustment for linkage increased the average "diagnostic days" to 23.1 in DIN. 32.7% of emollient prescriptions in GPRD appeared with an eczema diagnosis on the same day compared to only 19.4% in DIN; however, 86.4% of prescriptions in DIN were linked to an earlier eczema diagnosis. More specifically 83% of emollient prescriptions appeared under a problem heading of eczema in the 121 practices that were using problem headings satisfactorily. Conclusion Prescribing records in DIN and GPRD are very similar, but the usage of diagnostic codes is more parsimonious in DIN because of its POMR structure. Period prevalence rates will be underestimated in DIN unless this structure is taken into account. The advantage of the POMR is that in 121 of 141 practices using problem headings as intended, most prescriptions can be linked to a problem heading providing a specific reason for their issue

Understanding the stabilizing effect of histidine on mAb aggregation: a molecular dynamics study.

Histidine, a widely used buffer in monoclonal antibody (mAb) formulations, is known to reduce antibody aggregation. While experimental studies suggest a nonelectrostatic, nonstructural (relating to secondary structure preservation) origin of the phenomenon, the underlying microscopic mechanism behind the histidine action is still unknown. Understanding this mechanism will help evaluate and predict the stabilizing effect of this buffer under different experimental conditions and for different mAbs. We have used all-atom molecular dynamics simulations and contact-based free energy calculations to investigate molecular-level interactions between the histidine buffer and mAbs, which lead to the observed stability of therapeutic formulations in the presence of histidine. We reformulate the Spatial Aggregation Propensity index by including the buffer-protein interactions. The buffer adsorption on the protein surface leads to lower exposure of the hydrophobic regions to water. Our analysis indicates that the mechanism behind the stabilizing action of histidine is connected to the shielding of the solvent-exposed hydrophobic regions on the protein surface by the buffer molecules

Blended Wing Body Concept Development with Open Rotor Engine Intergration

The purpose of this study is to perform a systems analysis of a Blended Wing Body (BWB) open rotor concept at the conceptual design level. This concept will be utilized to estimate overall noise and fuel burn performance, leveraging recent test data. This study will also investigate the challenge of propulsion airframe installation of an open rotor engine on a BWB configuration. Open rotor engines have unique problems relative to turbofans. The rotors are open, exposed to flow conditions outside of the engine. The flow field that the rotors are immersed in may be higher than the free stream flow and it may not be uniform, both of these characteristics could increase noise and decrease performance. The rotors sometimes cause changes in the flow conditions imposed on aircraft surfaces. At high power conditions such as takeoff and climb out, the stream tube of air that goes through the rotors contracts rapidly causing the boundary layer on the body upper surface to go through an adverse pressure gradient which could result with separated airflow. The BWB / Open Rotor configuration must be designed to mitigate these problems

Chylous effusion presenting in a 37-year-old woman with severe hypothyroidism: a case report

<p>Abstract</p> <p>Introduction</p> <p>We report what is to the best of our knowledge the second adult case of chylothorax clearly associated with severe hypothyroidism in the English-language medical literature. To the best of our knowledge, this is the first case of its kind reported without a prior history of malignancy.</p> <p>Case presentation</p> <p>A 37-year-old Hispanic woman with no reported significant past medical history initially presented with shortness of breath and inability to lose weight. She was found to have a large chylous effusion requiring chest-tube drainage, as well as severe hypothyroidism. After several weeks of thyroid hormone-replacement therapy, the formation of chylous pleural fluid in the patient greatly diminished, and the chest tube was removed. Upon long-term follow-up her minimal residual effusion remains stable on serial chest radiographs.</p> <p>Conclusion</p> <p>Although the exact pathophysiologic relation between low thyroid hormone levels and chyle formation remains to be elucidated, hypothyroidism should be a diagnostic consideration in patients with chylous effusions, especially those refractory to conventional treatments.</p

Evolution of Low- and Intermediate-Mass Stars with [Fe/H] <= -2.5

We present extensive sets of stellar models for 0.8-9.0Msun in mass and -5 <= [Fe/H] <= -2 and Z = 0 in metallicity. The present work focuses on the evolutionary characteristics of hydrogen mixing into the He-flash convective zones during the core and shell He flashes which occurs for the models with [Fe/H] <~ -2.5. Evolution is followed from the zero age MS to the TPAGB phase including the hydrogen engulfment by the He-flash convection during the RGB or AGB phase. There exist various types of mixing episodes of how the H mixing sets in and how it affects the final abundances at the surface. In particular, we find H ingestion events without dredge-ups that enables repeated neutron-capture nucleosynthesis in the He flash convective zones with 13 C(a,n)16 O as neutron source. For Z = 0, the mixing and dredge-up processes vary with the initial mass, which results in different final abundances in the surface. We investigate the occurrence of these events for various initial mass and metallicity to find the metallicity dependence for the He-flash driven deep mixing (He-FDDM) and also for the third dredge-up (TDU) events. In our models, we find He-FDDM for M <= 3Msun for Z = 0 and for M <~ 2Msun for -5 <~ [Fe/H] <~ -3. On the other hand, the occurrence of the TDU is limited to the mass range of ~1.5Msun to ~5Msun for [Fe/H] = -3, which narrows with decreasing metallicity. The paper also discusses the implications of the results of model computations for observations. We compared the abundance pattern of CNO abundances with observed metal-poor stars. The origins of most iron-deficient stars are discussed by assuming that these stars are affected by binary mass transfer. We also point out the existence of a blue horizontal branch for -4 <~ [Fe/H] <~ -2.5.Comment: 19 pages, 12 figures, accepted by MNRA

Use of PDV to measure the overdriven products equation of state in PBX 9502 and PBX 9501 and the EOS in shocked foams

Author Institution: Los Alamos National LaboratorySlides presented at the 2014 Photonic Doppler Velocimetry (PDV) Workshop Hosted by National Security Technologies, LLC, and the University of Nevada Las Vegas, June 24-26, 2014, Las Vegas, Nevada

Predictors of treatment failure for non-severe childhood pneumonia in developing countries--systematic literature review and expert survey--the first step towards a community focused mHealth risk-assessment tool?

Improved referral algorithms for children with non-severe pneumonia at the community level are desirable. We sought to identify predictors of oral antibiotic failure in children who fulfill the case definition of World Health Organization (WHO) non-severe pneumonia. Predictors of greatest interest were those not currently utilized in referral algorithms and feasible to obtain at the community level

Health services research in the public healthcare system in Hong Kong: An analysis of over 1 million antihypertensive prescriptions between 2004-2007 as an example of the potential and pitfalls of using routinely collected electronic patient data

&lt;b&gt;Objectives&lt;/b&gt; Increasing use is being made of routinely collected electronic patient data in health services research. The aim of the present study was to evaluate the potential usefulness of a comprehensive database used routinely in the public healthcare system in Hong Kong, using antihypertensive drug prescriptions in primary care as an example.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; Data on antihypertensive drug prescriptions were retrieved from the electronic Clinical Management System (e-CMS) of all primary care clinics run by the Health Authority (HA) in the New Territory East (NTE) cluster of Hong Kong between January 2004 and June 2007. Information was also retrieved on patients’ demographic and socioeconomic characteristics, visit type (new or follow-up), and relevant diseases (International Classification of Primary Care, ICPC codes). &lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; 1,096,282 visit episodes were accessed, representing 93,450 patients. Patients’ demographic and socio-economic details were recorded in all cases. Prescription details for anti-hypertensive drugs were missing in only 18 patients (0.02%). However, ICPC-code was missing for 36,409 patients (39%). Significant independent predictors of whether disease codes were applied included patient age &gt; 70 years (OR 2.18), female gender (OR 1.20), district of residence (range of ORs in more rural districts; 0.32-0.41), type of clinic (OR in Family Medicine Specialist Clinics; 1.45) and type of visit (OR follow-up visit; 2.39). &lt;p&gt;&lt;/p&gt; In the 57,041 patients with an ICPC-code, uncomplicated hypertension (ICPC K86) was recorded in 45,859 patients (82.1%). The characteristics of these patients were very similar to those of the non-coded group, suggesting that most non-coded patients on antihypertensive drugs are likely to have uncomplicated hypertension. &lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusion&lt;/b&gt; The e-CMS database of the HA in Hong Kong varies in quality in terms of recorded information. Potential future health services research using demographic and prescription information is highly feasible but for disease-specific research dependant on ICPC codes some caution is warranted. In the case of uncomplicated hypertension, future research on pharmaco-epidemiology (such as prescription patterns) and clinical issues (such as side-effects of medications on metabolic parameters) seems feasible given the large size of the data set and the comparability of coded and non-coded patients