Dietary assessment can be based on pattern recognition rather than recall.

Diet is the leading predictor of health status, including all-cause mortality, in the modern world, yet is rarely measured; whereas virtually every adult in a developed country knows their approximate blood pressure, hardly any knows their objective diet quality. Leading authorities have called for the inclusion of nutrition in every electronic health record as one of the many remedial steps required to give dietary quality the routine attention it warrants. Existing tools to capture dietary intake are based on either real-time journaling or recall. Journaling, or logging, is time and labor intensive. Recall is notoriously unreliable, as humans are notably bad at remembering detail. Even allowing for the challenge of recall, these dietary intake methods are labor and time intensive, and require analysis at the n-of-1 level. We hypothesize that dietary intake assessment can be "reverse engineered"-predicating assessment on the recognition of fully formed dietary patterns-rather than endeavoring to assemble such a representation one food, meal, dish, or day at a time. This pattern recognition-based method offers potential advantages over existing methods, including speed, efficiency, cost, and applicability. We have developed and provisionally tested such a system, and the results thus far support our hypothesis. We are convinced that leveraging pattern recognition to make dietary assessment quick, user-friendly, economical, and scalable can allow for the conversion of dietary quality into a universally measured and routinely managed vital sign. In this paper, we present the supporting case.

Evaluation of long-term clinical and health service outcomes following coronary artery revascularisation in Western Australia (WACARP): a population-based cohort study protocol.

INTRODUCTION: Coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) are procedures commonly performed on patients with significant obstructive coronary artery disease to relieve symptoms of ischaemia, improve survival or both. Although the efficacy of both procedures at the individual level has been established, the impact of advances in coronary artery revascularisation procedures (CARP) on long-term outcomes and cost-effectiveness at the population level are yet to be assessed. Our aim is to evaluate a minimum of 6-year outcomes and costs for the total population of patients who had CARP in Western Australia (WA) in 2000-2005. METHODS AND ANALYSIS: This retrospective population cohort study will link clinical and administrative health data for a previously defined cohort including all patients in WA who had a CARP in the period 2000-2005. The cohort consists of 19,014 patients who had 21,175 procedures (15,429 PCI and 5746 CABG). We are now collecting a minimum of 6 years follow-up of morbidity and mortality data for the cohort using the WA Data Linkage System, clinical registries and hospital records, with 12 years follow-up for cases in the year 2000. Comparison of long-term outcomes for different CARP will be reported (PCI vs CABG; bare metal stents vs drug-eluting stents vs CABG). Cost-effectiveness analysis of CARP from the perspective of the healthcare sector will be performed using individual level cost data and average costs from Australian Refined Diagnosis Related Groups. ETHICS AND DISSEMINATION: This study has received ethics approval from the University of Western Australia, the Western Australian Department of Health and all participating hospitals. Being a large population cohort study, approval included a waiver of informed consent. All findings will be presented at local, national and international healthcare/academic conferences and published in peer-reviewed journals.

Cost effectiveness of the Expert Patients Programme (EPP) for patients with chronic conditions.

OBJECTIVE: To assess the cost effectiveness of the Expert Patients Programme (EPP) intervention compared to a treatment as usual alternative. DESIGN: Two-arm pragmatic randomised controlled trial design with waiting list control. SETTING: Community settings in England. PATIENTS: Patients with a wide range of self-defined long-term conditions. INTERVENTION: The EPP based on the US chronic disease self management program (CDSMP), a lay-led self-care group involving six weekly sessions to teach self-care support skills. MAIN OUTCOME MEASURES: Costs estimated over a 6-month period from a societal perspective. Health outcomes estimated in terms of quality adjusted life years (QALYs) generated by patients' response to the EQ5D at baseline and 6-month follow-up. RESULTS: The intervention group is associated with better patient outcomes, at slightly lower cost. Specifically, the intervention group has a 0.020 QALY gain compared with the control group, and a reduced cost of around 27 pounds per patient. The intervention would therefore be considered dominant. While the QALYs gained are small in absolute terms, an additional 0.02 QALY is equivalent to an extra one week of perfect health per year. When the value of a QALY is 20,000 pounds the EPP has a probability of 94% of being cost effective. Indeed, for all plausible values of willingness-to-pay for a QALY the EPP group is more likely to be cost effective than the control group. CONCLUSIONS: The EPP intervention evaluated in this trial is very likely to provide a cost effective alternative to usual care in people with long-term conditions.

How is money spent on children's services?

Finance and activity data for the year 1999-2000 were used to identify the money spent on children's services in health and social care in a county with a population of 790,000. Total costs were almost pound 80m. Considerable amounts were spent on high cost, low volume activity. Local health and social care commissioners require this information to implement and monitor changes in children's services, particularly in light of the UK government proposals for children's trusts.

Evaluation of capillary zone electrophoresis assessment of beta proteins.

OBJECTIVE: Evaluate capillary zone electrophoresis for analyzing beta proteins for concentrations of transferrin and complement. DESIGN: Thirty normal sera were used to establish expected ranges for these proteins by re-gating on the specific peaks from the original histograms. A total of 61 sera with elevated beta proteins were evaluated by this method. An additional 50 sera with an acute phase reaction were evaluated. SETTING: All tests were done at Baptist Regional Laboratories on a Beckman CZE/1000 2000 instrument. PATIENTS OR OTHER PARTICIPANTS: Sera were taken from excess sera used for clinical testing. Thirty normal serum donors were tested. The 61 sera with elevated beta proteins were evaluated on a prospective basis following clinical testing. The 50 sera with acute phase patterns were evaluated retrospectively following clinical testing. INTERVENTION: None RESULTS: Among the 61 sera with increased beta protein, 34 (56%) had elevated transferrin but 57 (93%) had elevated complement levels. In the 50 sera from the acute phase reactant group, 24 sera had elevated complement. OUTCOME: The study showed that capillary zone electrophoresis could effectively be used to evaluate specific levels of transferrin and complement without further testing. CONCLUSIONS: These findings show that with this method, transferrin and complement can be quantitatively measured without further analysis and that the majority of beta protein increases are due to elevated complement levels in our population.

Propagation of fluorescent light.

BACKGROUND AND OBJECTIVE: In general, the remitted fluorescence spectrum is affected by the scattering and absorption properties of tissue. Other important factors are boundary conditions, geometry of the tissue sample, and the quantum yield of tissue fluorophores. Each of these factors is examined through a series of Monte Carlo simulations. STUDY DESIGN/MATERIALS AND METHODS: Monte Carlo modeling is used to simulate the propagation of excitation light and the resulting fluorescence. Remitted fluorescence is determined for semi-infinite single and multiple layer geometries and for cubic geometries representing small tissue samples. Monte Carlo results are compared to approximations obtained with a heuristic model. RESULTS: Remitted fluorescence as a function of (1) the depth of fluorescence generation and (2) radial escape position is presented for semi-infinite single and multiple layer geometries. Fluorescence from a small tissue sample is simulated in terms of a cubic geometry, and losses from the sides and bottom are presented as a function of cube dimensions in terms of optical depth of the excitation wavelength. Monte Carlo results for a homogeneous semi-infinite layer are compared to a simple, fast heuristic model. CONCLUSION: Both Monte Carlo simulations and the heuristic model clearly detail the volume of tissue interrogated by fluorescence. Since approximately 35-40% of the remitted fluorescence is due to photons originally directed away from the surface, distal layers affect the remitted fluorescence. Fluorescence spectra from small biopsy samples may not produce the correct line shape owing to wavelength dependent losses.

Monte Carlo model for determination of the role of heat generation in laser-irradiated tissue.

A Monte Carlo model is described for modeling photo propagation in a scattering medium. The fraction of locally absorbed photons is proportional to the local rate of heat generation in laser-irradiated tissue and the associated distribution of light (fluence rate) is obtained by dividing the rate of heat generation by the local absorption coefficient. Examples of computed distributions of the rate of heat generation are presented for situations where light scattering in tissue is important. The method is applied to analyze treatment of Port Wine Stain and the selection of laser wavelengths for cyclophotocoagulation.

Light transport in tissue: Accurate expressions for one-dimensional fluence rate and escape function based upon monte carlo simulation.

BACKGROUND AND OBJECTIVE: Surface laser irradiation of tissue often produces a fluence rate that varies only with depth. Modeling of laser-induced fluorescence involves an expression for the fraction of fluorescence emitted per unit depth that escapes from the medium. We present accurate expressions for fluence rate and escape function for the one-dimensional case based upon Monte Carlo simulation results. STUDY DESIGN/MATERIAL AND METHODS: Expressions were proposed for fluence rate, phi (z)/E0 = C1exp (-k1z/delta)-C2exp(-k2z/delta), and escape function, G(z) = C3exp(-k3z/delta), that varied solely with depth relative to effective penetration depth, z/delta. The scalar (C) and exponential (k) coefficient values were found by curve fitting the expressions to Monte Carlo simulation results. RESULTS: The coefficients varied as smooth functions of diffuse reflectance, Rd, for the range Rd = 0.01-0.8, and were independent of scattering anisotropy in the range g = 0.7-0.9. Simple expressions approximated the relationship of each coefficient to Rd. CONCLUSION: The proposed expressions have accuracy comparable to Monte Carlo simulations, over an essentially unrestricted range of diffuse reflectance values. The expressions may be combined accurately to portray laser-induced fluorescence measurements of a turbid medium.

Monte Carlo simulation of light transport in tissue: unscattered absorption events.

A source of error in the Monte Carlo simulation of the fluence rate in turbid media is the inaccurate recording of unscattered absorption events. The form and magnitude of the error have been studied for Gaussian and uniform beam profiles simulated in cylindrical and Cartesian coordinates. In each case the error decreases as the lateral sampling lattice spacing decreases and is less than 2% of the incident peak irradiance when the beam radius is greater than five lattice spacings. To avoid the error, one may calculate analytically the fluence rate caused by unscattered absorption events.

Getting paid: how to charge and collect.

Providing quality service to an adequate client base is only part of the challenge of managing a dairy practice. Effective charging for services and efficient collection of charges is necessary for economic survival. Charging by procedure, by time, and by contract are alternatives discussed, as well as methods to manage accounts receivable.

Consultant utilization by family physicians in a university hospital practice.

All inpatient consultations obtained by family physicians at a university hospital were monitored for 2 1/2 years to determine the number and types of consultations obtained. Overall, 1,017 consultations were obtained on 2,155 patients (0.47 consultations per patient). The consultation rate, however, gradually decreased from 0.56 consultations per patient at the beginning of the study to 0.36 consultations per patient at the end of the study, probably corresponding to cost-containment pressures placed on physicians by increasing involvement with prepaid health care plans. The specialties most frequently consulted were cardiology, gastroenterology, neurology, and pulmonary medicine, which together accounted for more than one third of all consultations obtained.