Progress Toward Accurate Measurement of Dielectric Barrier Discharge Plasma Actuator Power.

The accurate measurement of power consumption by dielectric barrier discharge plasma actuators is a challenge due to the characteristics of the actuator current signal. Microdischarges generate high-amplitude, high-frequency current spike transients superimposed on a low-amplitude, low-frequency current. A high-speed digital oscilloscope was used to measure the actuator power consumption using the shunt resistor method and the monitor capacitor method. The measurements were performed simultaneously and compared to each other in a time-accurate manner. It was found that low signal-to-noise ratios of the oscilloscopes used, in combination with the high dynamic range of the current spikes, make the shunt resistor method inaccurate. An innovative, nonlinear signal compression circuit was applied to the actuator current signal and yielded excellent agreement between the two methods. The paper describes the issues and challenges associated with performing accurate power measurements. It provides insights into the two methods including new insight into the Lissajous curve of the monitor capacitor method. Extension to a broad range of parameters and further development of the compression hardware will be performed in future work.

A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease.

OBJECTIVE: To evaluate the efficacy and safety of a selective serotonin reuptake inhibitor (SSRI) and a serotonin and norepinephrine reuptake inhibitor (SNRI) in the treatment of depression in Parkinson disease (PD). METHODS: A total of 115 subjects with PD were enrolled at 20 sites. Subjects were randomized to receive an SSRI (paroxetine; n = 42), an SNRI (venlafaxine extended release [XR]; n = 34), or placebo (n = 39). Subjects met DSM-IV criteria for a depressive disorder, or operationally defined subsyndromal depression, and scored >12 on the first 17 items of the Hamilton Rating Scale for Depression (HAM-D). Subjects were followed for 12 weeks (6-week dosage adjustment, 6-week maintenance). Maximum daily dosages were 40 mg for paroxetine and 225 mg for venlafaxine XR. The primary outcome measure was change in the HAM-D score from baseline to week 12. RESULTS: Treatment effects (relative to placebo), expressed as mean 12-week reductions in HAM-D score, were 6.2 points (97.5% confidence interval [CI] 2.2 to 10.3, p = 0.0007) in the paroxetine group and 4.2 points (97.5% CI 0.1 to 8.4, p = 0.02) in the venlafaxine XR group. No treatment effects were seen on motor function. CONCLUSIONS: Both paroxetine and venlafaxine XR significantly improved depression in subjects with PD. Both medications were generally safe and well tolerated and did not worsen motor function. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that paroxetine and venlafaxine XR are effective in treating depression in patients with PD.

Design and performance evaluation of a broadband three dimensional acoustic intensity measuring system.

A seven-microphone three dimensional (3D) intensity measuring system has been developed and evaluated for performance for a broad frequency band (200 Hz-6.5 kHz). Six microphones are arranged in a concentric array with one microphone at the center of the probe. The screw adjustable center microphone is the probe reference microphone, and is used for calibrations of the other microphones in the probe. This probe addresses limitations of the traditional two-microphone system in measuring acoustical properties in a 3D space from the one dimensional measurements. This probe also eliminates the need of spacers used in the existing 3D probes for broadband measurements. Diffraction and reflection effects on calibrations due to presence of the microphones and the probe supporting structure are negligible. This seven-microphone probe provided better results in the intensity measurements for the wide frequency band than that of a similar four-microphone array probe.

Identification of diabetic complications among minority populations.

OBJECTIVE: In consideration of the increasing prevalence of diabetes, multiple factors related to levels of long-term glycemic control, and complex causes of racial disparities across a variety of chronic conditions, patterns of admissions and complications related to diabetes by ethnicity were explored to develop a more clear understanding of underlying causes of disparities. METHOD: Using the 2003 National Inpatient Sample, we analyzed the correlation between the primary diagnosis and the likelihood that the condition represented poorly controlled diabetes or a diabetes-related complication. RESULTS: Minorities were more likely to be admitted through the emergency department and for a condition directly related to diabetes progression. Further, minorities were more likely to be admitted for acute hyperglycemia and acute hypoglycemia. CONCLUSION: Interventions that address root causes of disparities related to diabetes and other conditions, such as care-seeking behaviors and ease of access to primary care providers, are keys to eliminating ethnic disparities.

Factors underlying racial disparities in hospital care of congestive heart failure.

OBJECTIVE: To examine relationships between race and five aspects of hospital care. METHODS: Cross-sectional data of 373,158 discharges with heart failure in the 1995-1997 National Inpatient Sample were used to measure severity, care-seeking patterns, processes, resource consumption, and outcomes. RESULTS: Compared to White patients, African American and Hispanic patients were more likely to seek care through the emergency department (ED) but less likely to receive clinical procedures or die in the hospital. Interactions of African American race with patient co-morbidity status, admission through the ED, and receipt of intensive services were associated with lower mortality as was interaction between admission to teaching hospitals and Hispanic race. CONCLUSIONS: Lack of access to ambulatory care among minority patients and hospital care via the safety net may contribute to racial discrepancies as a result of healthier patient selection among minority groups.

Ropinirole 24-hour prolonged release: randomized, controlled study in advanced Parkinson disease.

OBJECTIVE: To evaluate the efficacy of ropinirole 24-hour prolonged release (ropinirole 24-hour) as an adjunct to levodopa in patients with Parkinson disease (PD) and motor fluctuations. METHODS: In a double-blind, placebo-controlled, 24-week study, 393 subjects with PD were randomized to ropinirole 24-hour (n = 202) or placebo (n = 191). The primary outcome measure was reduction in hours of daily "off" time. RESULTS: At week 24, the mean dose of ropinirole 24-hour was 18.8 mg/day with a mean reduction in daily levodopa of 278 mg. There was a mean reduction in daily "off" time of 2.1 hours in the ropinirole 24-hour group and 0.3 hours with placebo. Secondary outcome measures including change in hours and percent of daily "on" time and "on" time without troublesome dyskinesia, Unified PD Rating Scale motor and activities of daily living subscales, Beck Depression Inventory-II, PDQ-39 subscales of mobility, activities of daily living, emotional well-being, stigma and communication, and PD Sleep Scale were significantly improved at week 24 with ropinirole 24-hour. The most common adverse events (AE) with ropinirole 24-hour were dyskinesia, nausea, dizziness, somnolence, hallucinations, and orthostatic hypotension and AEs led to study withdrawal in 5% of both the active and placebo groups. CONCLUSION: Ropinirole 24-hour was effective and well tolerated as adjunct therapy in patients with Parkinson disease (PD) not optimally controlled with levodopa. Ropinirole 24-hour demonstrated an improvement in both motor and non-motor PD symptoms, while permitting a reduction in adjunctive levodopa dose.

Disparities in outcomes among patients with stroke associated with insurance status.

BACKGROUND AND PURPOSE: Despite well-documented discrepancies in many clinical conditions across insurance groups, limited research has examined insurance-related disparities for patients with stroke. This study examined the relationship between insurance status and hospital care for patients with stroke. METHODS: Discharges with intracerebral hemorrhage and acute ischemic stroke were abstracted from the 2002 National Inpatient Sample. Neurologic impairment status and mortality were examined. RESULTS: Compared with privately insured patients, uninsured patients had a higher level of neurologic impairment, a longer average length of hospital stay, and higher mortality risk. For patients with intracerebral hemorrhage and acute ischemic stroke, mortality risk of uninsured patients was approximately 24% and 56% higher, respectively, than that of their privately insured peers. CONCLUSIONS: Policy should promote access to outpatient and preventive care for uninsured patients so risk factors such as hypertension can be detected and treated during early, asymptomatic stages. Further research is needed to evaluate the extent to which differences in outcomes are attributable to differences in severity level on admission.

Gender discrepancies in the level of disease progression in hospitalized patients with diabetes.

Diabetes is a widely recognized and common cause of mortality, morbidity, and excess cost in the health care system. Type 2 diabetes is specifically on the rise, particularly in association with the increasing obesity rate. Substantial literature has examined differences in behavior across genders and potential effect on disease. However, based on a literature review, little has been done to evaluate differences in patterns of diabetes related to inpatient care across genders and to link these differences with potential explanations related to differences in care-seeking behavior, treatment compliance, and lifestyle choices. This review and analysis of national inpatient data demonstrates substantial differences associated with gender in patterns of hospital-based care in patients with type 2 diabetes. Men are more likely to be admitted for diabetes-related conditions and to present with blood sugars at extreme levels, including acutely elevated and dangerous blood sugar levels. When considering these findings in conjunction with the existing literature, it can be concluded that these differences are primarily reflective of variances in care-seeking behavior and long-term adherence to prescribed medications. Policies that promote expansion of health care benefits to include coverage for men at risk for type 2 diabetes, aggressive education and treatment programs, and expanded prescription drug coverage are necessary to reduce gender discrepancies in patterns of hospitalization and to improve outcomes.

Care patterns for affective psychosis across diverse ethnicities: exploring potential contributors to complications and emergency room utilization.

OBJECTIVE: To explore associations between access to care and environmental stressors with emergency room admissions; to evaluate patterns of complications across diverse ethnic groups related to affective psychosis. METHODS: Data from the National Inpatient Sample were used to evaluate complications and frequency of hospitalization through the emergency room as a proportion of all hospital admissions for affective psychosis across diverse ethnic groups. Unemployment data, variations of trends of proportions of emergency room admissions after the September 11th tragedy, and ratios of primary care physicians/psychiatrists to the general population were evaluated. RESULTS: Admissions through the emergency room as a percentage of all admissions for affective psychosis decreased from 1995 through 1999 but increased in 2001, showing a potential association with increasing unemployment rates and the September 11th tragedy. Over the same period, relatively higher frequencies of emergency room admissions as a proportion of all hospital admissions among African Americans decreased. No significant differences for complications or emergency room utilization were observed between African Americans and Whites by 2001. During the entire period, frequencies of complications in the Hispanic and Asian populations remained lower than frequencies in both African American and White populations. No associations were found between physician-to-population ratios and utilization of the emergency room. CONCLUSION: Patterns of emergency room utilization and complications in African American and White populations appear to show some association with environmental stressors. Further study is warranted to evaluate protective factors associated with lower risk of complications in both Hispanic and Asian populations.

Rasagiline-associated motor improvement in PD occurs without worsening of cognitive and behavioral symptoms.

BACKGROUND: Cognitive and behavioral adverse events (AEs) such as hallucinations, confusion, depression, somnolence and other sleep disorders commonly limit effective management of motor symptoms in PD. Rasagiline (N-propargyl-1(R)-aminoindan) mesylate is a novel, second-generation, selective, irreversible monoamine oxidase type B inhibitor, demonstrated in monotherapy and adjunctive trials to be effective for PD with excellent tolerability. METHODS: The occurrence of cognitive and behavioral AEs and the change from baseline in the Unified Parkinson's Disease Rating Scale (UPDRS) part I mental subscores were reviewed in two multicenter, randomized, placebo-controlled, 26-week trials of rasagiline for early and moderate-to-advanced patients with PD. The UPDRS is a multi-item rating scale specific to PD; part I rates the patient's intellectual impairment, thought disorders, depression and motivation/initiative. RESULTS: The TEMPO study evaluated rasagiline monotherapy in early PD patients (n=404). The PRESTO study evaluated rasagiline as adjunctive therapy in moderate-to-advanced PD patients with motor complications who were receiving optimized levodopa/carbidopa (n=472). In the analysis of adverse event reporting for both studies, no cognitive and behavioral AE in either the rasagiline 1 mg or placebo groups exceeded 10% of the study population and the frequency differences between rasagiline 1 mg and placebo never exceeded 3%. There was no adverse effect on the UPDRS mental subscore relative to placebo in either of the two studies. CONCLUSION: Rasagiline 1 mg once daily improves PD symptoms and motor fluctuations in early and moderate-to-advanced PD patients without causing significant cognitive and behavioral AE or adverse changes in mentation, behavior and mood.

Barriers of HIPAA regulation to implementation of health services research.

Although many perspectives on the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) on health services research have been wide spread, little empirical evidence has been reported about HIPAA-related barriers during the implementation of research projects. Using three cases of health services research projects, this study examined practical barriers created by HIPAA regulation. During the stage of implementation of the three projects, we experienced some HIPAA-related concerns, previously raised in the field of health services research. We found that technically complicated consent forms and privacy protection forms as well as socially-sensitive clinical conditions make patients less willing to participate in research projects; concerns about safety of patient medical information makes health organizations more hesitant to let researchers have access to the patient's information, especially through electronic transfer; more restrictive IRB processes and challenging patient recruiting processes make health services researchers reluctant to go through the process; and as a result, they may compromise with the scientific soundness of the project. Overall, HIPAA complicates the research process and requires more resources and longer time to conduct research.

Oral health disparities in New York State.

New York State population is diverse, with a large proportion of racial and ethnic minorities. The poverty rate is two- to three-times higher among minorities. Oral diseases are higher among low-income and/or less-educated groups and in racial and ethnic minorities. The use of dental services is also lower. Eliminating disparities in oral health will require enhanced efforts at preventing disease, promoting health and delivering appropriate care. It will also require a thorough understanding of the lower use of already available effective preventive and treatment services, and additional interventions to address the identified causes. Many initiatives have been undertaken in New York State to address these disparities.

Patterns of hospital-based pediatric care across diverse ethnicities: the case of pneumonia.

Few studies have evaluated racial disparities with respect to process and outcome measures for pneumonia. We evaluated disparities with respect to process measures in addition to clinical and financial outcome measures in a pediatric population from 0 to 18 years of age. The data showed that minority populations were admitted at younger ages and were more likely to be admitted through the emergency department than their white counterparts. Substantial variation exists with respect to patterns of care and outcomes for pneumonia in pediatric patients among different ethnic/racial groups. Differences in outcomes may be associated with several factors, including variations in quality of care across different hospital settings, characteristics related to disease severity among different ethnic groups, and other unidentified factors. Further research is needed to clearly define how differences with respect to quality of care, access to care, disease severity, and care-seeking behaviors contribute to differences in outcomes across different ethnic groups.

Chondroblastoma of the temporal bone involving the temporomandibular joint, mandibular condyle, and middle cranial fossa: case report and review of the literature.

Chondroblastoma is a highly destructive tumor, derived from immature cartilage cells, typically occurring in epiphyses of the long bones of adolescents and young adults. Those occurring in the temporal bone and TMJ area are likely to mimic TMJ symptoms. This report describes a unique case in which a chondroblastoma resulted in extensive destruction of the temporal bone, temporomandibular joint, mandibular condyle, and cranial base, including gross intracranial and extracranial involvement. With appropriate surgical management, the outcome for patients with chondroblastoma of the temporomandibular region is quite favorable. This case brings the total reported chondroblastomas to 59 in the temporal bone and eight in the mandibular condyle as of the date of submission of this article for publication.

Racial disparities in the pathogenesis and outcomes for patients with ischemic stroke.

Using the 2000 National Inpatient Sample, this study examined the patterns of disparities regarding acute care outcomes of ischemic stroke among Caucasian, African-American, Hispanic, and Asian/Pacific-Islander patients. The data from 13,316 patients with carotid artery-related stroke and 33,149 patients with cerebral artery occlusion were examined. Although racial disparities associated with carotid artery occlusion and cerebral artery occlusion varied, overall, as compared with Caucasians, minorities suffered greater neurologic impairment and had poorer outcomes. For example, among patients with carotid artery occlusion, 62.5% of Caucasian patients had paralysis, compared with 71.2% of African Americans, 69.1% of Hispanics, and 74.0% of Asian patients. Poorer outcomes among African Americans and Hispanics coexisted with higher frequencies of cerebral artery disease in these populations, suggesting possible etiologic factors related to diabetes and high cholesterol levels. Etiologic factors contributing to disparities in the Asian population remain to be determined.

The New York State Minority Health Survey: determinants of oral health care utilization.

OBJECTIVES: To determine the factors associated with visits to a dentist and more specifically the role of dental insurance coverage and to explore the reasons for not visiting a dentist among minorities in New York State. METHODS: The Minority Health Survey was a one-time, statewide, random digit-dialed telephone survey. We drew a directed acyclic graph (DAG) of the potential determinants of oral health care utilization for our population of interest and modeled the independent variables as determinants of oral health care utilization. The data for this study were analyzed in SUDAAN using appropriate weights and variance adjustments that accounted for the complex sampling design. Hence, this report is generalizable to the New York State adult "minority" population. RESULTS: About 63 percent respondents had visited a dentist in the past one year. Having dental insurance (adjusted odds ratio [adj OR]=2.5), having more than high school education (adj OR=1.9), being younger (adj OR=2.3 for 18-25 years vs age 40 years or older), being married (adj OR=1.7), being dentate (adj OR=0.3 for edentulousness), and having higher income (adj OR=0.5 for middle vs high income) were significantly associated with having visited a dentist in the past year. Cost and awareness-related factors were the most common reasons for not visiting a dentist. Most of the year 2000 oral health objectives measurable in this survey were not met. CONCLUSION: Increasing dental insurance coverage and increasing awareness about oral health care would be the two biggest factors in meeting the goals of year 2010.

Early childhood caries-related visits to hospitals for ambulatory surgery in New York State.

OBJECTIVES: The objective of this study was to assess the utilization of ambulatory surgery at hospitals for the treatment of early childhood caries in New York State. METHODS: Data for this study came from the Statewide Planning and Research Cooperative System in New York State. We analyzed 16,149 oral health-related ambulatory surgeries performed between 1996 and 1999 in children younger than 6 years of age. RESULTS: Between 1996 and 1999, the rate of hospitalization for dental caries in children younger than 6 years of age ranged from 180 to 193 cases per 100,000. Approximately two-thirds of the visits by children younger than 6 years old were due to dental caries. The highest rate was observed in 3-year-old children (346.5). The most frequent type of procedure performed was placement of stainless steel crowns. Medicaid was the primary source of reimbursement. CONCLUSIONS: These data illustrate that, although dental caries is preventable, it continues to be a significant problem in young children and results in a large number of ambulatory surgery visits.

Internal validity of an anxiety disorder screening instrument across five ethnic groups.

We tested the factor structure of the National Anxiety Disorder Screening Day instrument (n=14860) within five ethnic groups (White, Black, Hispanic, Asian, Native American). Conducted yearly across the US, the screening is meant to detect five common anxiety syndromes. Factor analyses often fail to confirm the validity of assessment tools' structures, and this is especially likely for minority ethnic groups. If symptoms cluster differently across ethnic groups, criteria for conventional DSM-IV disorders are less likely to be met, leaving significant distress unlabeled and under-detected in minority groups. Exploratory and confirmatory factor analyses established that the items clustered into the six expected factors (one for each disorder plus agoraphobia). This six-factor model fit the data very well for Whites and not significantly worse for each other group. However, small areas of the model did not appear to fit as well for some groups. After taking these areas into account, the data still clearly suggest more prevalent PTSD symptoms in the Black, Hispanic and Native American groups in our sample. Additional studies are warranted to examine the model's external validity, generalizability to more culturally distinct groups, and overlap with other culture-specific syndromes.

Temporomandibular disorder treatment outcomes: second report of a large-scale prospective clinical study.

Longitudinal studies of outcomes for temporomandibular disorder (TMD) treatment are rarely done and even when conducted often suffer methodological weaknesses. These may include the lack of valid outcome measures for symptom changes. This second report of a long-term multi-site study of 2104 treated, 250 untreated, and 44 long-term treated TMD patients is part of a continuing effort to study TMD treatment efficacy in a very large patient population. A validated symptom measurement system, the TMJ Scale, assured a valid and uniform assessment of treatment outcomes across a large number of practices. Data indicate that untreated TMD patients do not improve spontaneously over time and that patients treated with a variety of active modalities achieve clinically and statistically significant levels of improvement with no evidence of symptom relapse after treatment completion. The use of anterior repositioning appliance therapy produced better results than flat plane splint therapy.