Epidemic influenza in Greater London.

The Kermack & McKendrick theory of epidemics has been applied to data on deaths from influenza and influenzal pneumonia in Greater London in the years 1950-78. As a whole the theory gives a good description of the data, and the estimated values of the parameters can be plausibly related to the natural history of the disease. However, the possibility exists that the agreement is merely empirical, and field studies would be required to confirm its validity.

Some points on the use of 'independent Bayes' to diagnose acute abdominal pain.

This paper outlines some of the difficulties encountered when using independent Bayes as a statistical decision aid for acute abdominal pain. Methods of reducing the resultant problems are suggested. Restriction of the number of facets in the system reduces violation of the simplifying assumption of symptom independence without adversely affecting efficiency. Introduction of a realistic utility structure is investigated as is the potential transportability of the decision aid. Generalizations of the results are discussed and potential uses of medical decision aids are considered.

Statistical analysis of heart rates in subsequent victims of sudden infant death syndrome.

An analysis was made of heart rate records obtained prospectively from a group of full-term infants. The group consisted of 16 subsequent victims of sudden infant death syndrome (SIDS) and a set of 49 controls. The power spectra were calculated for each record and this together with the birth weight, gestational age and age at recording provided the basis for a discriminant analysis. The analysis identified a periodicity of 6-8 heart beats, in addition to the known effect of low birth weight, as associated with the risk of SIDS.

Serum-albumin as a prognostic indicator in oedematous malnutrition.

Examination of the records of 340 children admitted to hospital in Uganda with oedematous malnutrition (kwashiorkor) showed that the serum-albumin concentration at admission was closely related to mortality-rates. Furthermore, in this series, it was not possible to show a simple relation between mortality-rates and the degree of wasting present. The results further emphasise the need to include serum-albumin concentration in international classification systems for the assessment of protein-energy malnutrition, especially that of the kwashiorkor type.

Hypertrophic scarring: Dexon suture in a randomized trial.

In a randomized prospective trial of three methods of skin suture an increased incidence of hypertrophic scarring in paramedian and inguinal wounds has been found to be associated with the use of 2/0 Dexon suture subcuticularly. However, the variance associated with the type of suture was less than that associated with the sex of the patient. The patient's opinion of the appearance of the scar was the same for all three suture methods used in skin closure.

Biochemical and haematological indicators of excessive alcohol consumption.

Discriminant function analysis was used to determine the optimum combination of haematological and biochemical tests which gave the best discrimination between hospital patients with high and low alcohol intakes. We studied 265 patients with alcohol-related disease, 133 gastroenterology outpatients drinking less than 20 g of alcohol per day, and 104 patients with a variety of non-alcoholic liver disease. Values of mean cell volume (MCV), serum bilirubin, aspartate transaminase, serum alkaline phosphatase (AP) and gamma glutamyl transferase (gamma GT), serum albumin, serum globulin, and uric acid were determined in each patient. The best discrimination between the three groups of patients was provided by a combination of mean corpuscular volume, log10 gamma GT, and log10 serum alkaline phosphatase. In women, 92% of the high alcohol group, 100% of the low alcohol group, and 87% of the non-alcoholic liver disease were correctly allocated by the discriminant analysis. The corresponding figures for the men were 80%, 100%, and 71%. Thus, over 80% of patients with excessive alcohol intake were correctly allocated by the use of three simple laboratory tests.

Assessment of severity in colitis: a preliminary study.

Clinical features, alone and in combinations of up to five, noted early in patients during 181 admissions to one hospital for treatment of acute colitis over five years, have been correlated with the success or failure of drug treatment as judged by death during medical treatment or the need for urgent surgical treatment. Many of the 56 clinical features studied were of no value in predicting the outcome of the attack. The four features of greatest predictive value were the maximum daily body temperature, the maximum daily pulse rate, the bowel frequency and plasma albumin. The simplest and most discriminating prediction at the end of the first 24 hours in hospital was obtained by combining observations on maximum body temperature and the number of stools passed. Serial observations of temperature or pulse rate over the first four days in hospital gave more prognostic information than observations confined to the first day. The predictive value of certain other features, such as x-ray appearances, is described. A simple classification of severity in acute colitis is proposed from these results as a basis for prospective testing in other hospitals.