Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era.

Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.

Salvaging legacy data: mapping an obsolete medical nomenclature to a modern one.

The Veterinary Medical Database (VMDB) is a repository containing abstracts of over six million case records from 24 veterinary colleges throughout the U.S. and Canada. These case record abstracts, spanning almost 40 years, represent a valuable resource for outcomes analysis and hypothesis generation. Database records are currently encoded using the Standard Nomenclature of Veterinary Diseases and Operations (SNVDO), a precoordinated, hierarchical coding system. SNVDO has not been updated since 1977 and is outdated and inadequate to express the current state of medical knowledge. We undertook to manually map a subset of the SNVDO codes to a modern medical nomenclature, SNOMED-RT (Version 1.0), and to evaluate the quality of the resultant mappings and the acceptability of the mapping method used. We found that the distribution of frequency of use of the SNVDO codes in the VMDB records is highly skewed, with a small number of codes accounting for a large percentage of the records. We targeted our mapping efforts on that subset of codes. We found that our targeted manual mapping of the SNVDO codes to SNOMED-RT codes was feasible and produced good quality results, based on separate evaluations performed by two domain experts. However, a significant proportion of the SNVDO codes could not be mapped to a single SNOMED-RT concept, necessitating construction of multiple-code post-coordinated terms. Additionally, this manual mapping was very labor-intensive.

Differential regulation of thrombospondin-1 and fibronectin by angiotensin II receptor subtypes in cultured endothelial cells.

OBJECTIVES: Angiotensin II (ANG II) can modulate cellular proliferation in various cell types via AT(1) and AT(2) receptors. In the present study, we investigated the effect of the angiotensin AT(1) and AT(2) receptors on DNA-synthesis as well as on the expression of the extracellular matrix (ECM) components, thrombospondin-1 (TSP-1) and fibronectin (FN) in endothelial cells (EC). METHODS: The experiments were performed in microvascular EC derived from rat heart (CEC) and macrovascular EC derived from bovine aorta (BAEC). The experiments were performed in cells of the second and third passage and the expression of AT(1) and AT(2) receptors was verified by binding studies, Northern analysis or RT-PCR. Quiescent rat CEC and BAEC were stimulated to proliferate by the addition of 25 ng/ml bFGF, while ANG II (10(-7) M) and the selective ANG II receptor antagonists, Losartan (10(-5) M) and PD123177 (10(-6) M) or the AT(2) agonist, CGP42112A (10(-7) M) were added 16 h later. RESULTS: ANG II induced a dose-dependent decrease of DNA-synthesis in BAEC measured by [3H]-thymidine incorporation. This inhibitory effect of ANG II was prevented by the addition of the AT(2) receptor antagonist PD123177 (10(-6) M), demonstrating, that the inhibition of DNA synthesis is mediated by the AT(2) receptor. In the presence of Losartan, stimulation of both, CEC and BAEC, with ANG II resulted in a marked increase of TSP-1 mRNA levels, which was maximal between 3 and 6 h in rat CEC and after 9 h in BAEC. In addition, TSP-1 was clearly induced by the AT(2) agonist CGP42112A. In contrast, blockade of the AT(2) receptor by the selective AT(2) antagonist, PD123177 (10(-6) M), resulted in a pronounced down regulation of FN mRNA 9 h after the stimulation. CONCLUSIONS: The present results suggest that the ANG II receptor subtype AT(2) mediates growth inhibition in macrovascular EC similar to what has been shown before in microvascular rat EC and that AT(2) receptors mediates remodeling of the endothelial ECM by upregulation of TSP-1 expression in both macro- and micro-vascular endothelial cells.

Spectral analysis of human tremor during cognitive tasks.

Many stresses occur in our daily lives. Some of these are part of diseases of the nervous system such as ataxia and neuroses. Certain body tremors may be related to these stresses. The rhythmic movement of various muscle groups, similar to a fast circadian rhythm, is defined as a tremor. These tremors, occurring during cognitive tasks, have been recorded by one-dimensional accelerometer in use in our laboratory. In this expanded study, we recorded three-dimensional body displacements with an optical motion capture system while subjects were performing the tasks of intent listening, reading and mental arithmetic calculations. The recorded displacements were subjected to spectral analysis using the Fast Fourier transform (FFT). The results indicate that the body vibration amplitude spectrum caused by mental arithmetic is significantly increased in the frequency rage of 0.5 to 0.7 Hz, when compared to those recorded during other tasks. The induced tremor, as well as general invisible body micro-vibration, were obtained from the three-dimensional body displacements.

On stethoscope design: a challenge for biomedical circuit designers.

Most clinicians learned the art and science of auscultation using an acoustic stethoscope. While many models of electronic stethoscopes have been marketed over the years, none of them seem to do a very good job of emulating the most common forms of acoustic stethoscopes available. This paper is an appeal to biomedical circuit designers to learn more about the acoustics of commonly used stethoscopes and to develop an appropriate group of circuits which would emulate them much like music synthesizers can emulate almost any musical instrument. The implications are for creative designers to move toward a rational and acceptable design for both personal physician use and for telemedicine.

A Web-based home helper support system.

A web-based "Home Helper" support system has been developed for improving scheduling and record keeping efficiency and for eliminating unnecessary travel. This support system consists of a wireless internet mobile phone for each "Home Helper" and a server at the main office. After each visit, the Home Helpers send their care reports via the mobile phone to the office server. This server computer then creates the "filings" automatically and in appropriate format for insurance and government use.

Developing a controlled vocabulary for use in a hospital information system.

In bringing a controlled vocabulary to a health information system, it is important to include those terms commonly used by those who must routinely input data to the system. We have developed a methodology whereby we can obtain "free text" descriptions of diagnoses entered by system users. We then sort those terms/concepts by system and find the appropriate "atomic" term(s). The terms are also being submitted to domain experts for appropriateness and fidelity. These concepts are then coded in an international coding system (SNOMED International) to eventually be entered into the controlled "pick list" of terms available for users to enter.

A microcomputer-based data acquisition system for ECG, body and ambient temperatures measurement during bathing.

A data acquisition system employing a low power 8 bit microcomputer has been developed for heart rate variability monitoring before, during and after bathing. The system consists of three integral chest electrodes, two temperature sensors, an instrumentation amplifier, a low power 8-bit single chip microcomputer (SMC) and a 4 MB compact flash memory (CFM). The ECG from the electrodes is converted to an 8-bit digital format at a 1 ms rate by an A/D converter in the SMC. Both signals from the body and ambient temperature sensors are converted to an 8-bit digital format every 1 second. These data are stored by the CFM. The system is powered by a rechargeable 3.6 V lithium battery. The 4 x 11 x 1 cm system is encapsulated in epoxy and silicone, yielding a total volume of 44 cc. The weight is 100 g.

Acquisition, storage, and transmission of multi-species electrocardiographic data.

We have developed a system for a remotely accessible secure entry and storage of electrocardiographic (ECG) and associated data. It allows entry of data as a scanned TIFF file from any authorized remote user and is specifically designed to accommodate ECGs of multiple species. The system runs on a dual processor Pentium-II with FreeBSD 3.0 as the operating system. The database used is MySQL 3.22 with interface routines written in C and Perl 5.005. The Web server used is Apache 1.3.4. No client is needed other than an Internet connected computer with a Web browser such as Netscape Communicator or Microsoft Internet Explorer.

A microcontroller-based telemetry system for sympathetic nerve activity and ECG measurement.

A telemetry system employing a low power 8-bit microcontroller has been developed for chronic unanesthetized small animal studies. The two-channel system is designed for use with animals in shielded cages. Analog signals from implantable ECG and nerve electrodes are converted to an 8-bit serial digital format. This is accomplished by individual 8 bit A/D converters included in the microcontroller, which also has serial I/O port. The converted serial binary code is applied directly to an antenna wire. Therefore, the system does not need to employ a separate transmitter, such as in FM or infrared optical telemeters. The system is used in a shielded animal cage to reduce interference from external radio signals and 60 Hz power line fields. The code is received by a high input impedance amplifier in the cage and is then demodulated. The telemeter is powered by a small 3 V lithium battery, which provides 100 hours of continuous operation. The circuit is constructed on two 25 x 25 mm. printed circuit boards and encapsulated in epoxy, yielding a total volume of 6.25 cc. The weight is 15 g.

PDGF-BB increases endothelial migration on cord movements during angiogenesis in vitro.

To explore direct effects of platelet-derived growth factor (PDGF) on endothelial cells during angiogenesis in vitro, we have used cloned bovine aortic endothelial cells that spontaneously form cord structures. Recently we have shown that cells forming these endothelial cords express PDGF beta-receptors and that PDGF-BB can contribute to cellular proliferation and cord formation. In this study we investigated whether PDGF-induced cellular migration might also contribute to endothelial repair and angiogenesis in vitro. Ten individual endothelial cells in cords were tracked at an early stage of cord formation by video-timelapse microscopy. PDGF-BB (100 ng/ml) induced an increase in endothelial cell movement of 67 +/- 15% as compared with diluent control. Interestingly, PDGF-BB also increased movements of entire cord structures, followed at branching points, by 53 +/- 12% over diluent control. Taken together, these video-timelapse experiments suggested that the apparent movements of single endothelial cord cells might also be due to the motion of entire underlying cord structures in response to PDGF. To analyze the response of single endothelial cord cells we therefore examined whether PDGF-induced migration contributes to endothelial repair. Abrasions were applied with a razor blade to confluent monolayers of endothelial cells at an intermediate stage of cord formation. PDGF-BB concentration-dependently increased the distance to which cord-forming endothelial cells migrated into the abrasion. An increased number of elongated, i.e., probably migrating, endothelial cells was found in the abrasion in response to PDGF-BB. However, there was no effect of PDGF-BB on the total number of endothelial cells found in the abrasion. PDGF-AA affected neither the distance to which the cells migrated nor the number of elongated cells. Actin and tubulin stainings revealed that these cytoskeletal structures were not appreciably altered by PDGF-BB. Furthermore, urokinase-type plasminogen activator transcripts were not modulated in response to PDGF-BB. We conclude that in this model of angiogenesis in vitro PDGF-BB can elicit the movement of entire cord structures, possibly via u-PA-independent mechanisms. PDGF-BB also controls the migration of single cord-forming endothelial cells. Thus, PDGF-BB possibly contributes to endothelial repair and angiogenesis by direct effects on proliferation and composite movements of PDGF beta-receptor-expressing endothelial cells and cords.

Influence of protamine on adhesion, chemotaxis and proliferation of human vascular smooth muscle cells.

It has been shown that, in streptozotocin diabetic rats, protamine-retarded insulin administered in vivo stimulates intimal hyperplasia in balloon-injured carotid artery. The aim of this study was to evaluate the influence of protamine on cultured human vascular smooth muscle cells (h VSMC), by observing its effects on adhesion, chemotaxis and proliferation. hVSMC were isolated during abdominal surgery, cultured and utilized at passages 6-10. We observed that protamine stimulates: 1) cell adhesion in the concentration range 0.04-20 micrograms/ml (analysis of variance, ANOVA, p < 0.0001); 2) cell chemotaxis in the absence of fetal calf serum (FCS) in the concentration range 1-200 micrograms/ml (ANOVA, p < 0.0001) and in the presence of 1% FCS in the concentration range 5-200 micrograms/ml (ANOVA, p < 0.0001), further enhancing the chemotaxis induced by 10% FCS in the concentration range 20-200 micrograms/ml (ANOVA, p < 0.0001); 3) cell proliferation and 3H-thymidine incorporation from 1 to 5 micrograms/ml (ANOVA, p < 0.0001); 4) cell c-fos oncoprotein nuclear expression. We also observed that protamine effects on chemotaxis, proliferation and c-fos expression are inhibited by heparin that human insulin stimulates cell proliferation and 3H-thymidine incorporation (ANOVA, p < 0.0001) at concentrations equal to or greater than 480 pmol/l and that these effects of insulin persist in the presence of protamine. In conclusion, protamine influences hVSMC behaviour by interfering with biological functions involved in atherogenesis. The concentrations used in this short-term in vitro study were higher than those probably occurring in vivo in patients chronically treated by protamine-retarded insulin preparations: further studies, therefore, are needed to evaluate the safety of protamine as a retardant of insulin action in vivo.

A personal digital assistant for determination of fluid needs for burn patients.

In most instances, the treatment of major burn victims begins in the emergency room of the hospital closest to the accident site. It can be assumed that the emergency room personnel in most hospitals rarely see patients with major burns. Thus, their experience with burn fluid resuscitation is often limited. Yet it is critical that primary early treatment of burn injury with fluid resuscitation begin before the patient is admitted locally or transferred to a burn unit. To assist these individuals a fluid resuscitation calculation application has been developed to run on a hand-held personal digital assistant (Palm Pilot). This hand-held application is meant to assist in emergency situations where time is short, thoughtful computation is not possible, and a quick determination of fluid replacement therapy is important for the survival of the patient.

Heart rate variability during exercise in the horse.

High heart rate variability (HRV) has been associated with more efficient autonomic control, allowing more responsivity and sensitivity to changing environmental demands. Previous results from spectral analysis of interbeat intervals of equine heart rate (HR) indicated increased HRV, reflecting more effective vagal control of the heart. This study focuses on characterizing equine HR and HRV during increasing then decreasing physical demand. A non-invasive ambulatory monitoring system continuously records HR and HRV as horses exercise on a high speed equine treadmill at increasing then decreasing workloads. After a 5 minute baseline, the horses walk, then trot, then canter or trot fast, return to the slower trot, then walk, and then remain quiet for a 5 minute recovery period. Results indicate a decrease of HRV and large individual differences in parasympathetic activity during exercise. Resulting patterns of HR fluctuation indicate a nonlinear dynamical approach may describe the task responses more completely than the more traditional models.

Special considerations for WEB-based clinical database applications.

The Hospital Information System at the University of Missouri-Columbia Veterinary Medical Teaching Hospital is implementing a web-based interface to the existing Hospital Information System. The "stateless" nature of HTML forms introduces a number of special considerations that, though not immediately obvious, nevertheless apply to any multi-user database application. Problems including identifying sessions and users, dealing with abandoned sessions or use of the "Back" arrow on the browser, record locking across multiple forms, state variables, and flow through "utility" forms. General solutions to each of these problems have been devised and are presented here.

Bringing a WEB-based interface to a hospital information system.

The Hospital Information System at the MU Veterinary Medical Teaching Hospital is a "home-grown" system written in MUMPS. The system has a "roll-and-scroll" user interface typical of terminal based systems from the 1970s and early 1980s. We are now introducing a new user interface that uses World Wide Web technology (HTML forms). Computers connected to the hospital's intranet can access the hospital system using the Web browser of the user's choice. The new user interface can run in parallel with the older interface (even on the same computer), and uses the same underlying database. This allows a smooth migration to the new interface which minimizes both user and programmer anguish. User acceptance has been good, and the ease and speed of development has been very promising.

Wavelet transforms for electrocardiogram processing.

Wavelet transforms were used to remove noise and detect characteristic points for feline and human electrocardiograms. The electrocardiograms contained both 60 Hz line noise and wideband noise. Noise was removed from the signals using both Fourier and wavelet techniques. For the Fourier technique, the signals were notch filtered at 60 Hz, and then low-pass filtered. To remove noise using wavelet techniques, the signals were wavelet-transformed and then soft thresholding was performed on each of the resulting details. The two methods of removing noise were then compared to illustrate the advantages of the wavelet approach. Wavelet transforms were also used to detect a characteristic point on each beat. An algorithm was written to find this point, calculate the instantaneous heart rate, and then plot heart rate variability.

A World Wide Web accessible multi-species ECG database.

We have developed a system for remotely accessible secure electronic storage of electrocardiographic (ECG) and other associated data. It allows entry of data from any authorized remote user and is specifically built to accommodate the ECGs of multiple species. The present system is implemented on a Sun Sparc Solaris 2.5 platform using Oracle 7.3.2, and the Oracle 7.3.2 Web server. It may be easily ported to any other UNIX or Windows NT platform. No client is needed other than an Internet Protocol connected computer using a web browser such as Netscape Navigator or Microsoft Internet Explorer.

Delivery of laboratory data with World Wide Web technology.

We have developed an experimental World Wide Web (WWW) based system to deliver laboratory results to clinicians in our Veterinary Medical Teaching Hospital. Laboratory results are generated by the clinical pathology section of our Veterinary Medical Diagnostic Laboratory and stored in a legacy information system. This system does not interface directly to the hospital information system, and it cannot be accessed directly by clinicians. Our "meta" system first parses routine print reports and then instantiates the data into a modern, open-architecture relational database using a data model constructed with currently accepted international standards for data representation and communication. The system does not affect either of the existing legacy systems. Location-independent delivery of patient data is via a secure WWW based system which maximizes usability and allows "value-added" graphic representations. The data can be viewed with any web browser. Future extensibility and intra- and inter-institutional compatibility served as key design criteria. The system is in the process of being evaluated using accepted methods of assessment of information technologies.