Multiobjective simulation-based methodologies for medical decision making.

A variety of methodologies have been employed for decision making related to the treatment of diseases/injury. Decision trees are a functional way in which to examine problems under uncertainty by providing a method to analyze decisions under risk (Detsky, 1996, 97). However, conventional decision trees do not completely represent the real world since they cannot investigate problems that are cyclic in nature (Jaafari, 2003). The stochastic tree that developed Hazen during 1992-to-1996 is one of the most relevant methods and techniques related to decision analyses that append more incorporation for medical intervention related to recurring diseases/injuries. The approach combines features of continuous-time Markov chains with those of decision trees and that enable time to be modeled as a range where health state transitions can occur at any instant (Hazen 1992-to-96). It can also accommodate patients\u27 preferences regarding risk and quality of life. In this research we enhance Hazen\u27s stochastic tree by developing an analytical model, and we extend its capabilities more by developing multi-objective simulation based methodologists for medical decision making. First, with our enhancement on the Hazen\u27s stochastic tree, the model is improved by utilizing the Weibull Accelerated Failure Time model. This new technique will fill the gap between the experimental circumstances and the corresponding circumstances or conditions of standard/current treatment. Second, as simulation can be a final alternative for problems that are mathematically intractable for other techniques (Banks 1996), our multi-objective simulation based model for medical decision making extends the capabilities of Hazen stochastic tree. It adds more flexibility with the use of survival distributions for health states sojourn, and combines two sound theories: multi attribute utility (MAU) theory, and Ranking-Selection procedures. Indeed, our simulation model (considering patient\u27s profile/preferences and health states survival/quality/cost, QALY) presents an investigation of the use of simulation on the stochastic tree, with associated techniques related to ranking and selection, and multi-objectives decision analysis

Neuroprotective peptide ADNF-9 in fetal brain of C57BL/6 mice exposed prenatally to alcohol

<p>Abstract</p> <p>Background</p> <p>A derived peptide from activity-dependent neurotrophic factor (ADNF-9) has been shown to be neuroprotective in the fetal alcohol exposure model. We investigated the neuroprotective effects of ADNF-9 against alcohol-induced apoptosis using TUNEL staining. We further characterize in this study the proteomic architecture underlying the role of ADNF-9 against ethanol teratogenesis during early fetal brain development using liquid chromatography in conjunction with tandem mass spectrometry (LC-MS/MS).</p> <p>Methods</p> <p>Pregnant C57BL/6 mice were exposed from embryonic days 7-13 (E7-E13) to a 25% ethanol-derived calorie [25% EDC, Alcohol (ALC)] diet, a 25% EDC diet simultaneously administered i.p. ADNF-9 (ALC/ADNF-9), or a pair-fed (PF) liquid diet. At E13, fetal brains were collected from 5 dams from each group, weighed, and frozen for LC-MS/MS procedure. Other fetal brains were fixed for TUNEL staining.</p> <p>Results</p> <p>Administration of ADNF-9 prevented alcohol-induced reduction in fetal brain weight and alcohol-induced increases in cell death. Moreover, individual fetal brains were analyzed by LC-MS/MS. Statistical differences in the amounts of proteins between the ALC and ALC/ADNF-9 groups resulted in a distinct data-clustering. Significant upregulation of several important proteins involved in brain development were found in the ALC/ADNF-9 group as compared to the ALC group.</p> <p>Conclusion</p> <p>These findings provide information on potential mechanisms underlying the neuroprotective effects of ADNF-9 in the fetal alcohol exposure model.</p

Mammography Social Support for Women Living in a Midwestern City: Toward Screening Promotion via Social Interactions

Notwithstanding recommendations and interventions, the percentage of 50 – 74-year-old U.S. women who reported having had a mammography in the past two years remained below target coverage. Social interactions may influence mammography rates. To measure characteristics of social interactions in a Midwestern city as they relate to social support for mammography received by women older than 40 years of age. A cross-sectional study was conducted in Bloomington, Indiana, sending mail surveys to 3,000 telephone directory addresses selected by simple random sampling. An anonymous, self-administered, closed-ended, questionnaire with eight checklist items (for demographics) and six multipart semantic differential scale items (for social support), derived from validated instruments, was used. Social support for mammography in women who had undergone regular screening was analyzed using chi-square test and logistic regression. Of 450 respondents with valid responses, 91% were white; 47% were older than 80; 92% had good health insurance coverage; and 82% had undergone regular mammography. Healthcare workers provided the highest support, followed by children, siblings, and relatives. Friends, neighbors, and co-workers were least supportive. In social interactions, emotional support was the most prominent, followed by informational, appraisal, and instrumental supports. Having higher income and being married were associated with receiving greater support. Although mammography provides limited benefits after age 74, women older than 80 years of age received the highest support. Identifying the structural and functional characteristics of social interactions is important for: 1) designing interventions that enhance social support, and 2) expanding breast cancer screening via personalized approaches using existing social interactions

Untying the Gordian Knot: The Development of an Immunization Information Exchange

Legislative mandates require the sharing of immunization information among multiple stakeholders. This in turn requires the implementation of interoperable systems across various information systems. A key challenge to system interoperability is the need to integrate healthcare information and processes across different settings. This paper reports work in progress on the development of a student immunization Health Information Exchange (HIE). The system builds on a commercially available platform, appropriately modified on both front and backend, to meet the needs of school health professionals and other stakeholders involved in the production and maintenance of immunization information. We describe the situated change perspective as well as the iterative and incremental development process adopted for the project, and examine some of the lessons learned throughout

Attenuated PTH Responsiveness to Vitamin D Deficiency among Patients with Type 2 Diabetes and Chronic Hyperglycemia

Background The short and long-term relationship between hyperglycemia and PTH level among patients suffering from both diabetes type 2 and vitamin D deficiency were evaluated. Methods This was a cross sectional study performed at Dubai Diabetes Center, UAE. To demonstrate the relationship between hyperglycemia and PTH level, subjects with type 2 diabetes and vitamin D deficiency (124 adults) were divided into 4 groups based on their FPG and HbA1c levels. Results Mean vitamin D and PTH levels among subjects with HbA1c ≤ 7% (53 mmol/mol) were 14.05 ng/ml and 19.51 pg/ml respectively. On the other hand, mean vitamin D and PTH levels among subjects with HbA1c ≥ 10% (86 mmol/mol) were significantly lower at 11.77 ng/ml and 17.75 pg/ml respectively. The product of vitamin D and PTH among subjects with an HbA1c ≤ 7% (53 mmol/mol) was 250.380, compared with only 197.710 among subjects with HbA1c ≥ 10 (86 mmol/mol). Regression analysis for subjects older than 50 years shows a significant negative effect of HbA1c on the PTH level. Mean calcium level among subjects with HbA1c ≤ 7% (53 mmol/mol) was 8.80 mg/dl compared with 8.94 mg/dl when HbA1c is ≥10% (86 mmol/mol) with no statistical difference. Although high FPG was associated with a lower PTH level, such association was not statistically significant. Conclusions Chronic hyperglycemia, as assessed by A1C level, is associated with a significantly attenuated PTH responsiveness to vitamin D deficiency without a significant change in calcium level. On the other hand, there was no significant association between FPG and PTH level