Prediction of flow induced sound generated by cross flow past finite length circular cylinders

The paper presents aeroacoustic results for the flow around finite-length circular cylinders at Reynolds number 84 770 for various length-to-diameter (L/D) ratios (= 3, 9, 20, 25, 30, and 35). The incompressible Navier-Stokes equations are solved using the large eddy simulation model of turbulence followed by acoustic predictions in the far field using Ffwocs Williams and Hawkings method. The comparisons of numerical and anechoic wind tunnel measurements show good agreement in terms of the aerodynamic forces and acoustic parameters such as tonal frequency, tonal sound pressure level, and overall sound pressure level. The cylinder L/D ratio was observed to be a significant parameter that controls vortex shedding and consequently the flow induced sound generation.

Smarter-lighter-greener: research innovations for the automotive sector

This paper reviews the changing nature of research underpinning the revolution in the automotive sector. Legislation controlling vehicle emissions has brought urgency to research, so we are now noticing a more rapid development of new technologies than at any time in the past century. The light-weighting of structures, the refinement of advanced propulsion systems, the advent of new smart materials, and greater in-vehicle intelligence and connectivity with transport infrastructure all require a fundamental rethink of established technologies used for many decades-defining a range of new multi-disciplinary research challenges. While meeting escalating emission penalties, cars must also fulfil the human desire for speed, reliability, beauty, refinement and elegance, qualities that mark out the truly great automobile.

Anti-inflammatory, anti-lipid peroxidative, antioxidant and membrane stabilizing activities of hydroalcoholic extract of Terminalia chebula fruits

CONTEXT

Arthritis is inflammation of one or more joints. Terminalia chebula Retz. (Combretaceae) fruit is mentioned in Ayurveda as useful in treating arthritic disorders.

OBJECTIVE

This work was undertaken to evaluate the anti-inflammatory, antioxidant, anti-lipid peroxidative and membrane-stabilizing effects of hydroalcoholic extract of Terminalia chebula fruits and also to establish a possible association between them.

MATERIALS AND METHODS

In vivo anti-inflammatory activity of T. chebula fruit extract at different doses ranged from 50 to 500 mg/kg, p.o. was evaluated against carrageenin-induced inflammation in rats. Human erythrocyte hemolytic assay was used for in vitro anti-inflammatory activity testing with 50 to 500 µg/ml fruit extract. Antioxidant potential of test fruit extract (10 to 100 µg/ml) was evaluated using TBARS and DPPH methods. The fruit extract was standardized for total phenolic content using Folin-Ciocalteu method.

RESULTS

The standardized extract at 250 mg/kg, p.o. dose caused 69.96% reduction in carrageenin-induced rat paw edema and demonstrated 96.72% protective effect on human RBC membrane stability. Besides, T. chebula fruit extract significantly reduced the in vivo formation of TBARS in carrageenin-induced rat liver with IC50 94.96 mg/kg, p.o. and also in vitro radical scavenging activities in DPPH assay method with IC50 42.14 µg/ml. The standardized extract contains phenolics 118.5 mg gallic acid equivalent/g of extract.

DISCUSSION AND CONCLUSION

These promising findings support the traditional use of T. chebula fruits in the treatment of arthritic disorders and suggest that radical quenching may be one of the mechanisms for its anti-inflammatory activity.

Antibacterial potential of hydroalcoholic extracts of triphala components against multidrug-resistant uropathogenic bacteria--a preliminary report

"Triphala", the Ayurvedic wonder is used traditionally for the treatment of different types of diseases since antiquity. The hydroalcoholic extracts of the three components of Triphala powder demonstrated varying degrees of strain specific antibacterial activity against multidrug-resistant uropathogenic bacteria. Terminalia chebula fruit extract was active against all the test isolates followed by Terminalia belerica and Emblica officinalis. There was a close association between antibacterial activity and total phenolic content of Triphala components.The test plant extracts were also found to be non-toxic on human erythrocyte membrane at recommended and even higher doses. The preliminary results of the present study may help in developing effective and safe antimicrobial agents from Triphala components for the treatment of urinary tract infections caused by multidrug-resistant bacteria.

The development of Terminalia chebula Retz. (Combretaceae) in clinical research

Medicinal plants are part and parcel of human society to combat diseases from the dawn of civilization. Terminalia chebula Retz. (Fam. Combretaceae), is called the 'King of Medicine' in Tibet and is always listed at the top of the list of 'Ayurvedic Materia Medica' because of its extraordinary power of healing. The whole plant possesses high medicinal value and traditionally used for the treatment of various ailments for human beings. Some of the folklore people used this plant in the treatment of asthma, sore throat, vomiting, hiccough, diarrhea, dysentery, bleeding piles, ulcers, gout, heart and bladder diseases. The plant has been demonstrated to possess multiple pharmacological and medicinal activities, such as antioxidant, antimicrobial, antidiabetic, hepatoprotective, anti-inflammatory, antimutagenic, antiproliferative, radioprotective, cardioprotective, antiarthritic, anticaries, gastrointestinal motility and wound healing activity. But no systematic updated information on the therapeutic effectiveness of Terminalia chebula, a popular herbal remedy in India and South-East Asia has so far been reported. This review highlights an updated information particularly on the phytochemistry and various pharmacological and medicinal properties of Terminalia chebula Retz. and some of its isolated compounds, along with their safety evaluation. This may provide incentive for proper evaluation of the plant as medicinal agent against the human diseases and also to bridge the lacunae in the existing literature and future scope which may offer immense opportunity for researchers engaged in validation of the traditional claims and development of safe and effective botanical medicine.

A randomized controlled trial comparing two different antibiotic regimens for prophylaxis at cesarean section

OBJECTIVES

To compare the efficacy of intravenous single dose, less costly cefotaxime and more expensive amoxycillin-clavulanic acid combination for prophylaxis at cesarean section.

METHOD

A double blind randomized controlled trial was undertaken on 760 subjects with two parallel treatment groups. Data were analyzed using Graphpad Instat 3 McIntosh software by Student's t test, Mann-Whitney U test, the Chi-squared test or fisher's exact test.

RESULTS

Comparatively narrow spectrum low cost cefotaxime is as effective as more expensive commonly used amoxicillin-clavulanic acid with no significant difference of infectious morbidity and hospital stay (p = 0.27 and 0.11 in elective and emergency cases respectively).

CONCLUSION

Less costly cefotaxime should be preferred compared to more costly amoxicillin-clavulanic acid combination for prophylaxis at cesarean section.

Perinatal outcome in pregnancies with intra-uterine growth restriction by using umbilical and middle cerebral artery colour Doppler

There are various biophysical methods used for diagnosing and monitoring foetal well being using in intra-uterine growth restriction foetus, out of which Doppler velocimetry proved to possess the predictive capacity in diagnosing and management of intra-uterine growth restriction foetuses. The objectives were to study Doppler velocimetry of foetal umbilical artery and middle cerebral artery in diagnosing intra-uterine growth restriction and to correlate Doppler finding with perinatal outcome. Random 50 patients with singleton pregnancies admitted in RG Kar Medical College and Hospital were studied in a duration of 1 year. Umbilical artery and middle cerebral artery were studied during foetal inactivity and apnoea. Percentage of normal and abnormal Doppler velocimetry of umbilical artery and middle cerebral artery was observed and its relation with perinatal outcome analysed. Out of 50 patients, 30% had normal and 70% had abnormal umbilical artery Doppler velocimetry. Neonatal intensive care unit admission was 20% in normal and 71.42% in abnormal umbilical artery Doppler, 46.4% in normal and 68.1% in abnormal middle cerebral artery Doppler and 9.09% in normal and 69.23% in abnormal cerebroplacental index. Neonatal mortality was 0% in normal and 14.3% in abnormal umbilical artery Doppler velocimetry. Oligohydramnios was 26% in normal and 71% in abnormal umbilical artery Doppler. The study revealed that overall perinatal outcome was poor in abnormal Doppler velocimetry group in comparison to normal group. Doppler investigation of the foetal circulation not only plays an important role in monitoring of the growth restricted foetuses but also helps in detecting foetal compromises early in intra-uterine growth restriction foetuses and thereby helps to determine the optimal time for delivery.

Normative data of cervical length in singleton pregnancy in women attending a tertiary care hospital in eastern India

BACKGROUND & OBJECTIVES

The length of cervix predicts the risk of preterm delivery. The objective of this study was to assess cervical length in pregnancy by transvaginal ultrasonography for generating normative data for nulliparous women at no special risk of preterm labour.

METHODS

An observational study was carried out in a tertiary care teaching hospital in eastern India in nulliparous women who delivered at term. A single sonologist assessed 224 women (once per subject) between 20 and 34 wk of gestation. Nulliparous women carrying a single foetus of confirmed gestational age were included; 216 subjects were finally considered for generation of normative data, excluding those delivering earlier than 37 or later than 42 wk. Other exclusion criteria were history of cerclage, any previous cervical surgery, smoking, or any medical disorder complicating pregnancy.

RESULTS

Cervix length at each week of gestation gradually decreased over the study period. Length at 20 and 34 wk was 40.5 ± 1.14 mm (mean ± SD) and 34.8 ± 1.34 mm respectively. The overall shortening over this 14 wk period was 5.7 mm, with 0.58 mm per week median rate of shortening. Pearson's correlation coefficient was -0.69 (95% CI -0.75 to -0.60; P< 0.001) for cervical length vis-à-vis gestational age.

INTERPRETATION & CONCLUSIONS

The serial normative data generated in our setting can be used to decide cut-off points for predicting risk of preterm labour in future studies. Validity of such prediction needs to be tested in larger cohorts of women assessed at specific gestational ages.

Reversible cortical blindness: posterior reversible encephalopathy syndrome

Cortical blindness is defined as visual failure with preserved pupillary reflexes in structurally intact eyes due to bilateral lesions affecting occipital cortex. Bilateral oedema and infarction of the posterior and middle cerebral arterial territory, trauma, glioma and meningioma of the occipital cortex are the main causes of cortical blindness. Posterior reversible encephalopathy syndrome (PRES) refers to the reversible subtype of cortical blindness and is usually associated with hypertension, diabetes, immunosuppression, puerperium with or without eclampsia. Here, 3 cases of PRES with complete or partial visual recovery following treatment in 6-month follow-up are reported.

Receiving sensitivity and transmitting voltage response of a fluid loaded spherical piezoelectric transducer with an elastic coating

A method is presented to determine the response of a spherical acoustic transducer that consists of a fluid-filled piezoelectric sphere with an elastic coating embedded in infinite fluid to electrical and plane-wave acoustic excitations. The exact spherically symmetric, linear, differential, governing equations are used for the interior and exterior fluids, and elastic and piezoelectric materials. Under acoustic excitation and open circuit boundary condition, the equation governing the piezoelectric sphere is homogeneous and the solution is expressed in terms of Bessel functions. Under electrical excitation, the equation governing the piezoelectric sphere is inhomogeneous and the complementary solution is expressed in terms of Bessel functions and the particular integral is expressed in terms of a power series. Numerical results are presented to illustrate the effect of dimensions of the piezoelectric sphere, fluid loading, elastic coating and internal material losses on the open-circuit receiving sensitivity and transmitting voltage response of the transducer.

A comparative study on sublingual versus oral and vaginal administration of misoprostol for late first and early second trimester abortion

To compare the effectiveness, side-effects and outcome of sublingual with oral and vaginal administrations of misoprostol for induction of abortion in late first and early second trimester of gestation (9 to 16 weeks), a comparative observational study was carried out among 258 women with a period of gestation between 9 and 16 weeks, scheduled to have medical abortion, and randomly allocated into three groups and offered sublingual, oral and vaginal routes of misoprostol administration (400 mcg of misoprostol 6 hourly, maximum up to four dosages) respectively. Primary outcome measure was complete abortion rate and the secondary outcome measures were incidence of cases where surgical evacuation required, failure rate and induction-abortion interval. Development of side-effects and subjective assessment of patient's comfort with the different routes of administration were also recorded. Rate of complete abortion was higher in sublingual group in comparison to oral (p = 0.0338) and vaginal route (p = 0.5627). Surgical evacuation was required in less number of cases in sublingual group. Induction-abortion interval was also least with the sublingual route le, p < or = 0.0001 (versus oral) and 0.0011 (versus vaginal). Failure rate was highest with the oral route and least with the sublingual route. The patients were least comfortable with the vaginal route. Gastro-intestinal side-effects were least with the vaginal route, but significant vaginal bleeding (> 250 ml) was little bit higher with this route. Though misoprostol is effective in inducing medical abortion irrespective of the route of administration, sublingual route gives better results as compared to oral (statistically significant) and vaginal routes (in some respects, not of much statistical significance).

Maternal mortality in India: a 20-year study from a large referral medical college hospital, West Bengal

AIM

The present study was carried out to analyze the maternal death rate and its changing trends over a 20-year period in a large referral/teaching institution in Eastern India.

METHODS

A retrospective analysis of maternal deaths was carried out from January 1986 to December 2005 at the Department of Obstetrics and Gynaecology, R. G. Kar Medical College and Hospital, Kolkata, India. Records were divided into four 5-yearly periods: 1986-1990; 1991-1995; 1996-2000; and 2001-2005, for comparison of the trends. The initial interval from 1986 to 1990 was chosen as the reference period.

RESULTS

The cumulative maternal mortality ratio (MMR) was 599.3 per 100 000 live births. Comparison between the first 5-year period (1986-1991) and the last (2001-2005) showed a statistical significant downward trend in MMR (683.6 vs 474.3; P < 0.001). Deaths due to direct causes are still the leading cause, accounting for 82.09% of total deaths. Hypertensive disorders (36.14%), hemorrhage (21.91%) and sepsis (19.54%) were still the major causes of direct obstetric deaths throughout the study period. Hypertensive disorders alone showed a substantial decline after the introduction of magnesium sulphate.

CONCLUSION

The fall in maternal mortality has been very slow.

Comparative evaluation of perimenopausal abnormal uterine bleeding by transvaginal sonography, hysteroscopy and endometrial biopsy

To evaluate the causes of abnormal uterine bleeding in perimenopausal women and to achieve the greatest diagnostic accuracy with the least risk, a cross-sectional study was done among 85 patients between the ages 40 and 55 years. Transvaginal sonography, hysteroscopy and histopathological examination of endometrium were done in all the cases. Kappa statistics was calculated to show the agreement between the different investigations. Considering histopathological report to be the gold standard, for diagnosis of hyperplastic endometrium, transvaginal sonography and hysteroscopy showed fair agreement (k=0.34) and good agreement (k=0.51) and hysteroscopic diagnosis of polyp showed strong agreement (k=0.81). Sensitivity, specificity, positive predictive value, negative predictive value for diagnosis of hyperplastic endometrium were 43.75%, 95.65%, 70% and 88% respectively whereas in polyp by transvaginal sonography they were 50%, 89.16%, 100%, 98.67% respectively; by hysteroscopy these were 50%, 95.78%, 70%, 90.36% respectively in hyperplasia and 71.43%, 100%, 100%, 94.67% respectively in polyp. Transvaginal sonography is most important for diagnosis of anatomical lesion. Hysteroscopy is most specific and sensitive for diagnosis of polyp but less specific for endometrial hyperplasia.

Complete perineal tear with rectal prolapse: an unusual case report

The association of complete perineal tear and rectal prolapse is less reported in literature, although isolated complete perineal tear and the combinations of vaginal and rectal prolapse are not so unusual, where multiparity and unsupervised home deliveries are quiet common. An interesting case of long standing complete perineal tear with complete rectal prolapse is reported in a 60 years old lady along with review of literature, discussing the management and follow-up of the condition.

Caesarean section for the dead baby--an unhappy reality

Caesarean section for the dead baby is sometimes still needed to prevent maternal complications. The objective of the study is to critically analyse the characteristics of the mother and indications for the operation in women who delivered stillbirths following caesarean section. The study period covered a 2 years span from January, 2003 to December, 2004. During this time 121 mothers (study group) underwent caesarean section for the dead baby representing 1.41% of all caesarean section operations done in the hospital. The study group was compared to the overall caesaren section done during the two years in relation to parity (parous 77.7% versus 45.7%), type of caesarean section (emergency 83.5% versus 69.8%) and timing of caesarean section within 12 hours of admission (74.4% versus 50.2%). Common indications in the study group included antepartum haemorrhage (31.4%), malpresentation (19.0%), postcaesarean pregnancies (16.5%), obstructed labour (15.7%), foetal distress (9.9%), second twin (4.1%) and eclampsia (3.3%). In some indications like obstructed labour and malpresentation, abdominal deliveries could be reduced by more destructive operations. The maternal reasons for resorting to caesarean section to save maternal lives are understandable. But caesaren section done for foetal distress was a disturbing revealation.

Two regimens of vaginal misoprostol in second trimester termination of pregnancy: a prospective randomised trial

BACKGROUND

The search continues for a safe, effective, and cheap method for mid-trimester termination of pregnancy. Misoprostol is a strong contender in this respect. The dose schedule of misoprostol is still not fixed. The objective of our present study was to compare the efficacy and adverse events of 2 dose regimens of vaginal misoprostol for second trimester termination.

METHOD

A prospective, randomised, controlled trial was undertaken in 138 women at 14-20 weeks gestation, in a teaching hospital. Subjects were randomised to receive either regime A: 400 microg of intravaginal misoprostol every 3 h, or regime B: loading dose of 600 microg, followed by 200 microg every 3 h. The main outcome measure was the success rate at 48 h, total dose required, induction-abortion interval, and adverse events. Data was analysed by Student's t-test, Mann-Whitney U-test, the chi-squared test or Fisher's exact test, using Statistica 6.0 software.

RESULTS

There was no significant difference in the success rates at 24 and 48 h (Regime A: 97.18 and 98.59%; Regime B: 95.45 and 95.45%), and in mean induction-abortion interval (12.97 versus 12.13 h). However, mean misoprostol requirement was significantly higher for Regime A (1701.4 versus 1269.7 microg). The incidence of fever was significantly less in Regime B (32.4 versus 14.9%).

CONCLUSION

Use of vaginal misoprostol for second trimester abortion had comparable efficacy with less drug requirement for the 600 microg loading dose followed by 200 microg 3-hourly regime compared to the 400 microg 3-hourly regime.

The prevalence of nocturia and its effect on health-related quality of life and sleep in a community sample in the USA

OBJECTIVE

To evaluate the prevalence of nocturia and its effects, with and without concomitant overactive bladder (OAB, i.e. urgency, frequency, urge incontinence and nocturia), on health-related quality of life (HRQoL) and sleep.

SUBJECTS AND METHODS

A national survey was conducted in the USA to assess the prevalence of OAB and nocturia. A nested case-control study was conducted among respondents with OAB symptoms and age- and gender-matched controls, with participants completing a series of questionnaires on HRQoL (OAB-q, Short Form-36, and Medical Outcomes Study (MOS) sleep scale). Descriptive analyses, t-tests, analysis of variance with post hoc comparisons and multivariate regressions were used to analyse the data.

RESULTS

In all, 5204 people participated in the survey, with 919 in the nested case-control study. The sample population had a mean age of 45.8 years, was 52.6% female and 80% Caucasian. In the community sample, 31% reported > 1 void/night and 14.2% reported > 2 voids/night. The prevalence of nocturia increased with age, with no gender differences. For OAB cases, 66.8% reported > 1 void/night and 42.2% reported > 2. In the case-control cohort there were significant HRQoL differences (P < 0.01), with increasing episodes of nocturia in all OAB-q subscales except social interaction. The amount of sleep per night was significantly correlated with the sleep, concern and social interaction OABq subscale scores. The number of nocturia episodes/night was also significantly (P = 0.02) associated with the number of hours of sleep/night.

CONCLUSION

Nocturia is widely prevalent and increases with age, affecting men and women equally. Incremental increases in the number of voids/night have further negative effects on sleep, symptom bother, and HRQoL.

Transient fluid-structure interaction of elongated bodies by finite-element method using elliptical and spheroidal absorbing boundaries

In a domain method of solution of exterior scalar wave equation, the radiation condition needs to be imposed on a truncation boundary of the modeling domain. The Bayliss, Gunzberger, and Turkel (BGT) boundary dampers, which require a circular cylindrical and spherical truncation boundaries in two-(2D) and three-(3D)-dimensional problems, respectively, have been particularly successful in the analysis of scattering and radiation problems. However, for an elongated body, elliptical (2D) or spheroidal (3D) truncation boundaries have potential to reduce the size of modeling domain and hence computational effort. For harmonic problems, such extensions of the first- and second-order BGT dampers are available in the literature. In this paper, BGT dampers in both elliptical and spheroidal coordinate systems have been developed for transient problems involving acoustic radiation as well as fluid-structure interaction and implemented in the context of finite-element method based upon unsymmetric pressure-displacement formulation. Applications to elongated radiators and shells are reported using several numerical examples with excellent comparisons. It is demonstrated that significant computational economy can be achieved for elongated bodies with the use of these dampers.

Transient acoustic radiation from impulsively accelerated bodies by the finite element method

Bodies under impulsive motion, immersed in an infinite acoustic fluid, severely put to test any numerical method for the transient exterior acoustic problem. Such problems, in the context of the finite element method (FEM), are not well studied. FE modeling of such problems requires truncation of the infinite fluid domain at a certain distance from the structure. The volume of computation depends upon the extent of this domain as well as the mesh density. The modeling of the fluid truncation boundary is crucial to the economy and accuracy of solution and various boundary dampers have been proposed in the literature for this purpose. The second order damper leads to unsymmetric boundary matrices and this necessitates the use of an unsymmetric equation solver for large problems. The present paper demonstrates the use of FEM with zeroth, first and second order boundary dampers in conjunction with an unsymmetric, out of core, banded equation solver for impulsive motion problems of rigid bodies in an acoustic fluid. The results compare well with those obtained from analytical methods.

An epidemiological survey of carcinoma cervix in north Bengal zone

Correlation between various epidemiological factors and carcinoma cervix patients in North Bengal zone has been studied for the first time. Significant correlation between elderly women (41-50 years age group), low socio-economic status (SES), first coitus before 17 years of age, low literacy rate and this illness has been established. Suggestion has been made for improvement of the picture. Oncology and radiotherapy department of North Bengal Medical College and Hospital should be utilised as the centre for National Cancer Registration Project in North Bengal zone.

Medical costs of managed care in patients with type 2 diabetes mellitus

The main objective of this study was to analyze the principal treatment cost drivers in patients with type 2 diabetes mellitus in a managed care setting. The study used retrospective integrated (linked) medical and pharmacy claims data for the calendar year 1995. The data were obtained from, and in cooperation with, the Hawaii Medical Service Association, Honolulu, Hawaii. The medical claims data included paid claims for services and procedures for diabetes and commonly associated comorbidities. Claims and associated costs for pharmacotherapy administered to the patient population were recorded in the pharmacy data. Patients aged > or =65 years were excluded because Medicare claims were unavailable for the type 2 diabetic population. The sample used in this study included 5171 patients. An ordinary least squares regression model was employed to identify principal cost drivers among the identified cohort to the managed care system. Independent variables in the analysis consisted of the presence or absence of a number of commonly observed comorbidities associated with diabetes mellitus (hypertension, hyperlipidemia, cardiovascular diseases, congestive heart failure, renal disorders, retinopathy, neurologic disorders, and any cardiac or noncardiac comorbidity combinations), pharmacologic therapy variables (insulin, oral medication, or both), a number of significant events (hospitalization, dialysis, hemoglobin A1c testing, and eye examination), patient enrollment category (fee-for-service vs a capitated system), and patient age and sex. The dependent variable was the natural logarithm of total medical costs of treatment for diabetes and commonly observed comorbidities. Results showed that among comorbidity variables, the 3 largest treatment cost drivers for patients with type 2 diabetes were the presence of neurologic disorders, renal disorders, and any comorbidity combination (cardiac or noncardiac or both), in decreasing order of significance. Similarly, higher costs of treatment were associated with episodes of hospitalization, use of antidiabetic medication, dialysis services, and hemoglobin A1c testing. Whether the patient was being treated under a capitated provider payment system or a fee-for-service system did not have any significant impact on the medical costs of diabetes-related treatment. Age was positively associated with these costs, indicating that older patients were more likely to incur higher costs to the system. The overall explanatory power of the model was 40%. In summary, unless diabetes is properly managed and glucose levels monitored, some component of an integrated health system (hospital vs pharmacy) necessarily bears financial risk. An understanding of the underlying cost distribution for a chronic disease could help in targeting interventions, integrating disease-management services, and managing the formal structure of the health plan being considered.

Predicting hospitalisation of patients with diabetes mellitus. An application of the Bayesian discriminant analysis

The objective of this study was to develop, and subsequently test, a Bayesian discrimination model for the purpose of identifying both the personal and the healthcare system characteristics predictive of hospitalisation for the treatment of patients with diabetes mellitus or commonly observed cormorbidities associated with the disease. First, a Bayesian classification framework was proposed. The model was then tested by using a logit regression technique in order to estimate the probability of one or more hospitalisation events among patients with diabetes. The study used claims data extracted from the Hawaii Medical Service Association (HMSA) Private Business Claims (PBS) files for the 1995 calendar year. Patients under 65 years were identified by paid claims with ICD-9-CM diagnosis codes of 250.xx which gave a sample size of 6841 patients. Age, gender, various pharmacotherapy variables, presence of hypertension, hyperlipidaemia, congestive heart failure, multiple cardiovascular diseases, any combination of commonly observed comorbidities, dialysis services and annual eye examination are highly predictive of 1 or more hospitalisation events. The model shows a predictive power of almost 90%. This study found that multivariate discriminant analysis using a logit regression model successfully identifies: (i) important explanatory variables predictive of hospitalisation; (ii) assigns patients into 1 of 2 mutually exclusive classes; and (iii) offers a benchmark for a comprehensive disease management strategy for patients with more complicated diabetes.

Monitoring patients with diabetes mellitus: an application of the probit model using managed care claims data

The primary objective of this study was to estimate the likelihood of the use of either a glycosylated hemoglobin (HbA1c) test or an eye examination, or both, among a cohort of patients diagnosed with diabetes mellitus. A secondary objective was to provide a step-by-step discussion of the applicability of an econometric model to managed care organizations. The study used medical and pharmacy claims data from a managed care organization for the calendar year 1995. A probit regression model was specified to estimate the probability of occurrence for either an HbA1c test or an eye examination among patients with insulin-dependent, non-insulin dependent, or atypical/unclassified diabetes. Data were available only for patients under 65 years of age due to data truncation for patients covered by Medicare, resulting in a study sample size of 6,841. Results indicate that age, presence of hypertension, hyperlipidemia, multiple cardiovascular comorbidities, ophthalmic disease, and combinations of multiple commonly observed comorbidities were positively correlated with the probability of either HbA1c testing or eye examination. Gender and the type of benefit plan were not statistically significant as predictors of disease monitoring. A total of 1,860 patients with diabetes mellitus were predicted by the model to have undergone one of the two monitoring procedures; but in actuality, these patients were not monitored in 1995. They could be considered as high-risk patients who were not getting recommended monitoring. The probit model shows a predictive power of 64.48%.

Treatment costs, equilibrium, and the allocation of patients to therapy alternatives

This paper addresses the problem of increasing costs (or decreasing returns) in the treatment of patients within health care systems. We examine the implications of such a situation for (1) the allocation of patients to alternative drug therapies within a disease area; and (2) the proportions of patients being treated within the disease area to the total patient population as a function of the equilibrium conditions for maximized health care outcomes, given alternative assumptions about the existence of budget constraints on the resources allocated to the disease area. The reason for considering these issues (in this case, from a purely theoretical perspective) is that such a model and the assumptions that drive it stand in marked contrast to those underlying (implicitly if not explicitly) the traditional approach to cost-effectiveness modeling. In traditional cost-effectiveness analysis, the assumption is that costs and outcomes exhibit constant returns to scale and that the process of patient selection and the characteristics of the treating population need not be taken into account. However, our analysis demonstrates that once the assumption of constant returns in abandoned, any assessment of the net impact of therapeutic interventions can be made only within an equilibrium, or comparative static, framework that is subject to budget constraints and in which the cost functions that drive patterns of switching between therapies are specified. Under such conditions, the traditional, clinical-trial-based notion of cost-effectiveness loses all meaning.

A genetic study among the Lepchas of the Darjeeling area of eastern India

A total of 215 Lepchas (75 Buddhists and 140 Christians) living in the Kalimpong subdivision, Darjeeling district, West Bengal, India, were investigated for the distribution of haemoglobin, serum proteins and red cell enzymes. The gene frequencies were as follows: HbE = 0.02; Hp1 = 0.18; TfB = 0.007; TfDChi = 0.005; Gc2 = 0.22; pa = 0.18; pc = 0.03; PGM2(1) = 0.18; PGM6(1) = 0.002; PGDc = 0.17; AK2 = 0.02; GLO1 = 0.21. The most striking features were the complete lack of G6PD deficiency and very high frequency of PGDC. The remaining loci (serum albumin, lactate dehydrogenase, malate dehydrogenase and glucose-6-phosphate dehydrogenase, phosphohexose isomerase and superoxide dismutase) were monomorphic. The gene frequencies were similar in the Buddhist and Christian Lepchas. The observed average heterozygosity (9 loci) was 0.20 in the entire sample.

Kaolin powder as a fungal carrier

Kaolin powder may be used to carry and preserve an Aspergillus sp. for at least 90 days without contamination and with retention of its activity in softening and upgrading barky jute.

The limited utility of fibrinogen I 125 leg scanning

Using venography as the reference procedure, this study examined the utility of fibrinogen I 125 scanning for the detection or demonstration of deep venous thrombosis. The results demonstrate the inability of leg scanning to detect accurately the presence or absence of thrombi in the deep venous system. Most striking was the lack of sensitivity of this procedure in areas where the propensity for embolization is greatest. Sensitivity is extremely low in the anatomic areas where leg scanning demonstrates reasonable specificity. The results are nearly identical in the extremity not operated upon. The validity of all prior studies relying heavily or exclusively on 125I leg scans to determine the presence or absence of thrombi must be critically reassessed.