The T4:TBG ratio: a re-evaluation with particular reference to low and high serum TBG levels.

The thyroxine: thyroxine-binding globulin (T4: TBG) ratio is now an established part of the biochemical investigation of thyroid function. Reference ranges have been reported for euthyroid subjects with TBG levels within the range 6-16 mg/l. Routine assay of TBG on all thyroid function tests in this laboratory has suggested that, in patients with low or high TBG levels, the established reference ranges for T4: TBG may not be strictly applicable. A retrospective study has been made of a large number of thyroid function requests, including serum total T4, free T4, TBG, and TSH assays. Evidence is presented to show that in subjects with a TBG level of less than 8 mg/l the reference range for T4: TBG is elevated. Similarly, in subjects with a TBG greater than 16 mg/l, the reference range for T4: TBG is lowered. The data suggest that it is necessary to quote a T4: TBG reference range based on small increments of TBG levels or to relate total T4 reference ranges to those increments.

A regional external quality assessment scheme for serum thyroxine-binding globulin.

The results from a Regional External Quality Assessment Scheme for the assay of serum thyroxine binding globulin (TBG) are presented. It has been shown that different methods of analysis (eg, rocket immuno-electrophoresis, radioimmunoassay, and radial immunodiffusion) produce comparable results using a common calibrant. Since there is no commonly agreed universal calibrant for TBG, however, results (in mg/l) for various assay systems with differing methods of calibration show wide variance.

Metaphrase: an aid to the clinical conceptualization and formalization of patient problems in healthcare enterprises.

Patient descriptors, or "problems," such as "brain metastases of melanoma" are an effective way for caregivers to describe patients. But most problems, e.g., "cubital tunnel syndrome" or "ulnar nerve compression," found in problem lists in an Electronic Medical Record (EMR) are not comparable computationally--in general, a computer cannot determine whether they describe the same or a related problem, or whether the user would have preferred "ulnar nerve compression syndrome." Metaphrase is a scalable, middleware component designed to be accessed from problem-manager applications in EMR systems. In response to caregivers' informal descriptors it suggests potentially equivalent, authoritative, and more formally comparable descriptors. Metaphrase contains a clinical subset of the 1997 UMLS Metathesaurus and some 10,000 "problems" from the Mayo Clinic and Harvard Beth Israel Hospital. Word and term completion, spelling correction, and semantic navigation, all combine to ease the burden of problem conceptualization, entry and formalization.

Effect of mutations on the detection of translational signals based on a communications theory approach.

Gene and regulatory sequence identification is the first step in the functional annotation of any genome. Identification and annotation of such elements in the genome is a fundamental challenge in genomics and computational biology. Since regulatory elements are often short and variable, their identification and discovery using computational algorithms is difficult. However, significant advances have been made in the computational methods for modeling and detection of DNA regulatory elements. This paper proposes a novel use of techniques and principles from communications engineering and coding theory for modeling, identification and analysis of genomic regulatory elements and biological sequences. The last 13 bases sequence in the 16S rRNA molecule was used as a test sequence and was detected using the proposed models. Results show that the proposed models are not only able to identify this regulatory element (RE) in the mRNA sequence, but also can help identify coding from noncoding regions. The models described in this work where used to study the effect of mutations in the last 13 bases sequence of the 16S rRNA molecule. The obtained results showed total agreement with published investigations on mutations which further certify the biological relevance of the proposed models.

A novel gene detection method based on period-3 property.

Processing of biomolecular sequences using communication theory techniques provides powerful approaches for solving highly relevant problems in bioinformatics by properly mapping character strings into numerical sequences. We provide an optimized procedure for predicting protein-coding regions in DNA sequences based on the period-3 property of coding region. We present a digital correlating and filtering approach in the process of predicting these regions, and find out their locations by using the magnitude of the output sequence. These approaches result in improved computational techniques for the solution of useful problems in genomic information science and technology.

A clinical terminology in the post modern era: pragmatic problem list development.

A brief review of the rich heritage of classifications and terminologies is the background for a description of the Mayo Clinic's clinical terminology development. Vender specific system constraints prompted the scope and style of an interim problem list vocabulary. We describe the sources and review process which led to a working terminology for use in a Computer-based Patient Record (CPR). Because terminology development is often subjective and metrics against which to measure the quality of individual human judgements are few, we decided to compare the selection of preferred terms made by general internists with those made by sub-specialists. A significant difference between a sub-specialist's assignment of preferred terms and a general internist's (948 vs. 2271, P < 0.001) was observed. Sub-specialists were less than half as likely as a generalist to designate a term as a preferred form. These results emphasize the need for sub-specialty editing when assigning preferred terms to concepts.

A study on the effects of severe repetitive exercise on serum myoglobin, creatine kinase, transaminases and lactate dehydrogenase.

Two groups of young men taking part in a 24-day training course involving increasingly severe exercise were studied. Serum myoglobin, creatine kinase, creatine kinase-MB, transaminases, lactate dehydrogenase, urea, creatinine, calcium and uric acid were estimated at intervals. During the first few days, increases in myoglobin and muscle enzymes correlated with the severity of the preceding exercise. Increases in myoglobin and muscle enzymes after the final most severe exercising were less than with the initial exercising, demonstrating the effect of physical training. The changes in myoglobin and the muscle enzymes correlated closely. Elevated myoglobin levels persisted for over 24 hours. There was no consistent correlation between changes in myoglobin and uric acid, both of which have been considered responsible for the renal failure which may occur with rhabdomyolysis.

Standardized problem list generation, utilizing the Mayo canonical vocabulary embedded within the Unified Medical Language System.

UNLABELLED: VOCABULARY: The Mayo problem list vocabulary is a clinically derived lexicon created from the entries made to the Mayo Clinic's Master Sheet Index and the problem list entries made to the Impression/ Report/Plan section of the Clinical Notes System over the last three years. The vocabulary was reduced by eliminating repetition including lexical variants, spelling errors, and qualifiers (Administrative or Operational terms). Qualifiers are re-coordinated with other terms, at run-time, which greatly increased the number of input strings which our system is capable of recognizing. IMPLEMENTATION: The Problem Manager is implemented using standard windows tools in a Windows NT environment. The interface is designed using Object Pascal. HTTP calls are passed over the World Wide Web to a UNIX based vocabulary server. The server returns a document, which is read into Object Pascal structures, parsed, filtered and displayed. STUDY: This paper reports the results of a recent Usability Trial focused on assessing the viability of this mechanism for standardized problem entry. Eight clinicians engaged in eleven scenarios and responded as to their satisfaction with the systems performance. These responses were observed, videotaped and tabulated. Clinicians in this study were able to find acceptable diagnoses in 91.1% of the scenarios. The response time was acceptable in 92.5% of the scenarios. The presentation of related terms was stated to be useful in at least one scenario by seven of the eight participants. All clinicians wanted to make use of shortcuts which would minimize the amount of typing necessary to encode the concept they were searching for (e.g. Abbreviations, Word Completion). CONCLUSIONS: Clinicians are willing to choose a canonical term from a suggested list (as opposed to their own wording). Clinicians want an "intelligent" system, which would suggest terms within a category (e.g. Types of "Migraine"). They are able to make functional use of our system, in its current state of development. Finally, all clinicians appreciate the value of encoding their problems in a standardized vocabulary, toward improved research, education and practice.