Thrombolytic therapy for acute myocardial infarction: A cohort study to evaluate a selective approach to invasive diagnosis and therapy. The Corpus Christi Heart Project

Coronary perfusion with thrombolytic therapy and selective reperfusion by percutaneous transluminal coronary angioplasty (PTCA) were examined in the Corpus Christi Heart Project, a population-based surveillance program for hospitalized acute myocardial infarction (MI) patients in a biethnic community of Mexican-Americans (MAs) and non-Hispanic whites (NHWs). Results were based on 250 (12.4%) patients who received thromobolytic therapy in a cohort of 2011 acute MI cases. Out of these 107 (42.8%) underwent PTCA with a mean follow-up of 25 months. There were 186 (74.4%) men and 64 (25.6%) women; 148 (59.2%) were NHWs, 86 (34.4%) were MAs. Thrombolysis and PTCA were performed less frequently in women than in men, and less frequently in MAs than in NHWs.^ According to the coronary reperfusion interventions used, patients were divided in two groups, those that received no-PTCA (57.2%) and the other that underwent PTCA (42.8%) after thrombolysis. The case-fatality rate was higher in no-PTCA patients than in the PTCA (7.7% versus 5.6%), as was mortality at one year (16.2% versus 10.5%). Reperfusion was successful in 48.0% in the entire cohort and (51.4% versus 45.6%) in the PTCA and no-PTCA groups. Mortality in the successful reperfusion patients was 5.0% compared to 22.3% in the unsuccessful reperfusion group (p = 0.00016, 95% CI: 1.98-11.6).^ Cardiac catheterization was performed in 86.4% thrombolytic patients. Severe stenosis ($>$75%) obstruction was present most commonly in the left descending artery (52.8%) and in the right coronary artery (52.8%). The occurrence of adverse in-hospital clinical events was higher in the no-PTCA as compared to the PTCA and catheterized patients with the exception of reperfusion arrythmias (p = 0.140; Fisher's exact test p = 0.129).^ Cox regression analysis was used to study the relationship between selected variables and mortality. Apart from successful reperfusion, age group (p = 0.028, 95% CI: 2.1-12.42), site of acute MI index (p = 0.050) and ejection-fraction (p = 0.052) were predictors of long-term survival. The ejection-fraction in the PTCA group was higher than (median 78% versus 53%) in the no-PTCA group. Assessed by logistic regression analysis history of high cholesterol ($>$200mg/dl) and diabetes mellites did have significant prognostic value (p = 0.0233; p = 0.0318) in long-term survival irrespective of treatment status.^ In conclusion, the results of this study support the idea that the use of PTCA as a selective intervention following thrombolysis improves survival of patients with acute MI. The use of PTCA in this setting appears to be safe. However, we can not exclude the possibility that some of these results may have occurred due to the exclusion from PTCA of high risk patients (selection bias). ^

A case-control study to identify risk factors for preterm labor in Colorado Springs, Colorado

The study objectives were to determine risk factors for preterm labor (PTL) in Colorado Springs, CO, with emphasis on altitude and psychosocial factors, and to develop a model that identifies women at high risk for PTL. Three hundred and thirty patients with PTL were matched to 460 control patients without PTL using insurance category as an indirect measure of social class. Data were gathered by patient interview and review of medical records. Seven risk groups were compared: (1) Altitude change and travel; (2) Psychosocial ((a) child, sexual, spouse, alcohol and drug abuse; (b) neuroses and psychoses; (c) serious accidents and injuries; (d) broken home (maternal parental separation); (e) assault (physical and sexual); and (f) stress (emotional, domestic, occupational, financial and general)); (3) demographic; (4) maternal physical condition; (5) Prenatal care; (6) Behavioral risks; and (7) Medical factors. Analysis was by logistic regression. Results demonstrated altitude change before or after conception and travel during pregnancy to be non-significant, even after adjustment for potential confounding variables. Five significant psychosocial risk factors were determined: Maternal sex abuse (p = 0.006), physical assault (p = 0.025), nervous breakdown (p = 0.011), past occupational injury (p = 0.016), and occupational stress (p = 0.028). Considering all seven risk groups in the logistic regression, we chose a logistic model with 11 risk factors. Two risk factors were psychosocial (maternal spouse abuse and past occupational injury), 1 was pertinent to maternal physical condition ($\le$130 lbs. pre-pregnancy weight), 1 to prenatal care ($\le$10 prenatal care visits), 2 pertinent to behavioral risks ($>$15 cigarettes per day and $\le$30 lbs. weight gain) and 5 medical factors (abnormal genital culture, previous PTB, primiparity, vaginal bleeding and vaginal discharge). We conclude that altitude change is not a risk factor for PTL and that selected psychosocial factors are significant risk factors for PTL. ^

A STUDY TO INVESTIGATE DIET DIVERSITY AS A NUTRITION ASSESSMENT INSTRUMENT

Nutrient intake and specific food item data from 24-hour dietary recalls were utilized to study the relationship between measures of diet diversity and dietary adequacy in a population of white females of child-bearing age and socioeconomic subgroups of that population. As the basis of the diet diversity measures, twelve food groups were constructed from the 24-hour recall data and the number of unique foods per food group counted and weighted according to specified weighting schemes. Utilizing these food groups, nine diet diversity indices were developed.^ Sensitivity/specificity analysis was used to determine the ability of varying levels of selected diet diversity indices to identify individuals above and below preselected intakes of different nutrients. The true prevalence proportions, sensitivity and specificity, false positive and false negative rates, and positive predictive values observed at the selected levels of diet diversity indices were investigated in relation to the objectives and resources of a variety of nutrition improvement programs. Diet diversity indices constructed from the total population data were evaluated as screening tools for respondent nutrient intakes in each of the socioeconomic subgroups as well.^ The results of the sensitivity/specificity analysis demonstrated that the false positive rate, the false negative rate, or both were too high at each diversity cut-off level to validate the widespread use of any of the diversity indices in the dietary assessment of the study population. Although diet diversity has been shown to be highly correlated with the intakes of a number of nutrients, the diet diversity indices constructed in this study did not adequately represent nutrient intakes in the diet as reported, in this study, intakes as reported in the 24-hour dietary recall. Specific cut-off levels of selected diversity indices might have limited application in some nutrition programs. The results were applicable to the sensitivity/specificity analyses in the socioeconomic subgroups as well as in the total population. ^

Los desafíos del uso combinado de un cuestionario estructurado y un calendario de historia de vida para el estudio de trayectorias laborales

El presente artículo se enmarca en un proyecto de investigación más amplio, realizado en la localidad de Ministro Rivadavia en el Partido de Alte. Brown. La investigación tiene como objetivo evaluar los procesos de movilidad, estancamiento y marginalización social en el período 1994-2008, para una población con elevados índices de pobreza e inserciones laborales precarias e informales. En este estudio nos proponemos reflexionar sobre los desafíos que implicó la articulación entre un cuestionario estructurado y un calendario de historia de vida para el análisis de trayectorias laborales. El trabajo presenta las características de la metodología empleada, discute sus antecedentes teórico-metodológicos y especifica dónde se inscribe la articulación metodológica propuesta en el mapa posible de estrategias de investigación sociológica. A lo largo del artículo, retomamos los debates y propuestas en torno al manejo de la dimensión temporal y presentamos distintos esquemas de análisis centrados en la consideración del tiempo en sus múltiples manifestaciones micro y macrosociales. El artículo contribuye al debate sobre la integración de estrategias de investigación cualitativas y cuantitativas, y evidencia las potencialidades del instrumento propuesto para captar la temporalidad en su carácter plural y multidimensional

Los desafíos del uso combinado de un cuestionario estructurado y un calendario de historia de vida para el estudio de trayectorias laborales

El presente artículo se enmarca en un proyecto de investigación más amplio, realizado en la localidad de Ministro Rivadavia en el Partido de Alte. Brown. La investigación tiene como objetivo evaluar los procesos de movilidad, estancamiento y marginalización social en el período 1994-2008, para una población con elevados índices de pobreza e inserciones laborales precarias e informales. En este estudio nos proponemos reflexionar sobre los desafíos que implicó la articulación entre un cuestionario estructurado y un calendario de historia de vida para el análisis de trayectorias laborales. El trabajo presenta las características de la metodología empleada, discute sus antecedentes teórico-metodológicos y especifica dónde se inscribe la articulación metodológica propuesta en el mapa posible de estrategias de investigación sociológica. A lo largo del artículo, retomamos los debates y propuestas en torno al manejo de la dimensión temporal y presentamos distintos esquemas de análisis centrados en la consideración del tiempo en sus múltiples manifestaciones micro y macrosociales. El artículo contribuye al debate sobre la integración de estrategias de investigación cualitativas y cuantitativas, y evidencia las potencialidades del instrumento propuesto para captar la temporalidad en su carácter plural y multidimensional

Los desafíos del uso combinado de un cuestionario estructurado y un calendario de historia de vida para el estudio de trayectorias laborales

El presente artículo se enmarca en un proyecto de investigación más amplio, realizado en la localidad de Ministro Rivadavia en el Partido de Alte. Brown. La investigación tiene como objetivo evaluar los procesos de movilidad, estancamiento y marginalización social en el período 1994-2008, para una población con elevados índices de pobreza e inserciones laborales precarias e informales. En este estudio nos proponemos reflexionar sobre los desafíos que implicó la articulación entre un cuestionario estructurado y un calendario de historia de vida para el análisis de trayectorias laborales. El trabajo presenta las características de la metodología empleada, discute sus antecedentes teórico-metodológicos y especifica dónde se inscribe la articulación metodológica propuesta en el mapa posible de estrategias de investigación sociológica. A lo largo del artículo, retomamos los debates y propuestas en torno al manejo de la dimensión temporal y presentamos distintos esquemas de análisis centrados en la consideración del tiempo en sus múltiples manifestaciones micro y macrosociales. El artículo contribuye al debate sobre la integración de estrategias de investigación cualitativas y cuantitativas, y evidencia las potencialidades del instrumento propuesto para captar la temporalidad en su carácter plural y multidimensional

Using a journal availability study to improve access

Purpose: Identify journal collection access and use factors.

Putting ion channels to work: Mechanoelectrical transduction, adaptation, and amplification by hair cells

As in other excitable cells, the ion channels of sensory receptors produce electrical signals that constitute the cellular response to stimulation. In photoreceptors, olfactory neurons, and some gustatory receptors, these channels essentially report the results of antecedent events in a cascade of chemical reactions. The mechanoelectrical transduction channels of hair cells, by contrast, are coupled directly to the stimulus. As a consequence, the mechanical properties of these channels shape our hearing process from the outset of transduction. Channel gating introduces nonlinearities prominent enough to be measured and even heard. Channels provide a feedback signal that controls the transducer's adaptation to large stimuli. Finally, transduction channels participate in an amplificatory process that sensitizes and sharpens hearing.

Study to assess the compensation and skills of medical library professionals relative to information technology professionals*

Purpose: The study seeks to determine how medical library professionals performing information-technology (IT) roles are compensated and how their positions are designed compared to information technology staff in their institutions.

An evolutionary approach to the delineation of functional areas based on travel-to-work flows

This paper presents a new approach to the delineation of local labor markets based on evolutionary computation. The aim of the exercise is the division of a given territory into functional regions based on travel-to-work flows. Such regions are defined so that a high degree of inter-regional separation and of intra-regional integration in both cases in terms of commuting flows is guaranteed. Additional requirements include the absence of overlap between delineated regions and the exhaustive coverage of the whole territory. The procedure is based on the maximization of a fitness function that measures aggregate intra-region interaction under constraints of inter-region separation and minimum size. In the experimentation stage, two variations of the fitness function are used, and the process is also applied as a final stage for the optimization of the results from one of the most successful existing methods, which are used by the British authorities for the delineation of travel-to-work areas (TTWAs). The empirical exercise is conducted using real data for a sufficiently large territory that is considered to be representative given the density and variety of travel-to-work patterns that it embraces. The paper includes the quantitative comparison with alternative traditional methods, the assessment of the performance of the set of operators which has been specifically designed to handle the regionalization problem and the evaluation of the convergence process. The robustness of the solutions, something crucial in a research and policy-making context, is also discussed in the paper.