Milwaukee County Research Articles

Does the Number of System Paramedics Affect Clinical Benchmark Thresholds?

Objective. Competency is affected by skill exposure, skill complexity, andtraining program quality. The purpose of this study was to reevaluate the biennial (24-month) critical care skill andexperience benchmark thresholds established by the Milwaukee County Emergency Medical Services (MCEMS) system in 1997. Methods. This was a retrospective review of annual experience profiles for paramedics working during 2001–2005 using the MCEMS patient care record (PCR) database. The number of patient contacts, role as team leader/report writer, adult andpediatric endotracheal intubations, adult andpediatric intravenous (IV) access initiations, medication administration, and12-lead electrocardiogram (ECG) acquisitions were analyzed. t-tests anddescriptive statistics were performed for comparison with the 1997 study. Results. Over the five-year study period, 1,215 paramedic profiles gleaned from 107,524 PCRs documented a total of 297,900 patient contacts. Annual means ± standard deviations [ranges] were as follows: patient contacts 245 ± 133 [12–788]; team leader: 106 ± 119 [0–739]; intubations: adult 2.57 ± 2.54 [0–20], pediatric 0.1 ± 0.3 [0–3]; IV starts: adult 44 ± 37 [0–267], pediatric 0.34 ± 0.77 [0–5]; treated cardiac arrests: adult 8 ± 6 [0–34], pediatric 0.26 ± 0.61 [0–4]; treated hypotensive trauma: 5 ± 6 [0–42]; andECGs acquired: 31 ± 19 [0–144]. The 1997 analysis (1987–1996 data) included 1,450 paramedic profiles representing 467,559 patient contacts generated from 172,131 filed PCRs. All comparable experiences decreased significantly between the 1997 analysis andthe current study, except medication administration, which increased 25%. Conclusion. These data show a decreased opportunity anda wide variability in the frequency of successfully completed paramedic technical skills andexperiences in this EMS system. Limited exposure to critically ill adult andpediatric patients reaffirms that high-risk skills are performed infrequently. A multifaceted approach should be considered for maintaining provider competency.

Language Barriers to Prescriptions for Patients With Limited English Proficiency: A Survey of Pharmacies

Twenty-three million Americans have limited English proficiency. Language barriers can have major adverse consequences in health care, but little is known about whether pharmacies provide adequate care to patients with limited English proficiency. We sought to evaluate pharmacies' ability to provide non-English-language prescription labels, information packets, and verbal communication, and assess pharmacies' satisfaction with communication with patients who have limited English proficiency. We used a cross-sectional, mixed-methods survey of Milwaukee County, Wisconsin, pharmacies. Survey questions addressed sociodemographic and language-service characteristics of pharmacies. A pharmacist or technician at each pharmacy was asked 45 questions by telephone, fax, or mail. The main outcome measures were the ability of pharmacies to provide non-English-language prescription labels, information packets, and verbal communication; and pharmacy satisfaction with communication with patients who have limited English proficiency. Of 175 pharmacies, 73% responded. Forty-seven percent of the pharmacies never/only sometimes can print non-English-language prescription labels, 54% never/only sometimes can prepare non-English-language information packets, and 64% never/only sometimes can verbally communicate in non-English languages. Eleven percent use patients' family members/friends to interpret. Only 55% were satisfied with their communication with patients who have limited English proficiency. In multivariate analyses, community pharmacies had significantly lower odds of being able to verbally communicate in non-English languages, whereas pharmacies using telephone interpreting services had significantly higher odds. Pharmacies' suggestions for improving patient communication included continuing education, producing a chain-wide list of resources, hiring bilingual staff, using telephone interpreters, analyzing translation quality/accuracy of labels and information packets, and adding more languages to pharmacy software. Approximately half of Milwaukee pharmacies never/only sometimes can provide non-English-language prescription labels or information packets, and approximately two thirds never/only sometimes can verbally communicate in non-English languages. One in 9 pharmacies that verbally communicate in non-English languages use patients' family members/friends to interpret. Almost half of the pharmacies are dissatisfied with their communication with patients who have limited English proficiency. Community pharmacies are less likely and pharmacies using telephone interpreting services are more likely to be able to verbally communicate in non-English languages. Study findings indicate that improvements in pharmacies' communication with patients who have limited English proficiency may result by increasing the quality and number of non-English languages in existing computer programs, hiring bilingual staff, and using telephone interpreting services when in-person interpreters are unavailable.

Barriers to Employment among TANF Applicants and Their Consequences for Self-Sufficiency

This article examines the prevalence of potential barriers to employment using data from a longitudinal study of 1,075 Milwaukee County parents who applied for assistance from Wisconsin's TANF program in 1999. It also examines whether those potential barriers were related to their subsequent employment and earnings. We find that many of these TANF applicants faced significant and often multiple barriers to employment. Moreover, these potential barriers were associated with both a reduction in their likelihood of being employed and lower earnings when they worked. The implications of these findings for welfare policy and practice are discussed.

Development of a Church-Based Cancer Education Curriculum Using CBPR

Development of a Church-Based Cancer Education Curriculum Using CBPR Barbra Beck PhD (bio), Staci Young MS (bio), Syed Ahmed MD, DrPH (bio), and Marie Wolff PhD (bio) Keywords Community-based participatory research, cancer, patient education, African American, church Introduction Cancer is the second leading cause of death (following heart disease) in the United States. An estimated 1.4 million cases of invasive cancer were diagnosed in the U.S. in 2005.1 Racial and ethnic minorities constitute a disproportionate number of these cases. African Americans have both higher cancer incidence and higher rates of cancer mortality than Whites. For instance, African American men are 20% more likely than White males to be diagnosed with cancer and are 40% more likely to die, considering all cancers combined. The five year survival rate for African American women diagnosed with breast cancer is 75%, compared with 89% for White females. Differences in survival rates are due to various factors, including poverty, disparities in treatment, reduced access to medical care, and diagnosis at a later stage.2 In general, African Americans have a decreased likelihood of surviving five years after diagnosis for all cancer types in comparison with Whites. Wisconsin cancer incidence and mortality rates mirror national patterns. From 1996 through 2000, Wisconsin's average cancer mortality rate was 195.7 per 100,000 for the whole population and 271.6 per 100,000 for African Americans. The state average for cancer incidence was 454.3 per 100,000 compared with 523.5 per 100,000 for African Americans. Milwaukee County, located in southeastern Wisconsin, has the highest concentration of African Americans in the state (24.6%) and, not surprisingly, significantly higher cancer mortality and incidence rates than the state as a whole (488.7 per 100,000 compared with 218.9 per 100,000, respectively).3 In April 2002 the Center for Healthy Communities (CHC) in the Department of [End Page 28] Family and Community Medicine at the Medical College of Wisconsin (MCW) began to address these cancer disparities by forming a partnership with the MCW Cancer Center, a local hospital, and an African American church. The goal of this partnership is to change inaccurate myths, perceptions, knowledge, and negative attitudes and behaviors concerning cancer. This report will describe the partnership and the collaborative process used to develop, implement, and evaluate a culturally appropriate, literacy-accessible church-based cancer prevention curriculum for underserved African American communities. Partnership Background The CHC was developed in 1997 to form community-academic partnerships to improve health. The Center operates with a philosophy of working with communities instead of doing things to or for them.4,5 In early 2002, the Center joined with the MCW Cancer Center, a local hospital, and a well-respected African American church to provide culturally appropriate cancer education and prevention information, understandable even for those with limited literacy, to the church's faith community. Traditionally, churches have been deeply rooted in African American communities and represent a trusted social institution second in importance only to the family.6 Churches have a strong tradition of caring for people in need and providing fellowship, support, and education. In many low-income neighborhoods, churches provide short-term emergency assistance to individuals and families in the form of food, clothing, and shelter.7 The faith community, particularly the African American church, has been a partner and/or site for the delivery of health education messages for at least the past two decades.8 Programs that encourage healthy eating, early and routine mammograms, and prostate screening have all been successfully implemented at African American churches throughout the country. 9,10,11,12,13 A community-based participatory research (CBPR) approach was used to develop and implement a series of activities within the church to increase cancer awareness and knowledge, and to motivate participants to seek recommended screening and early detection. Community-based participatory research is a collaborative partnership approach to research that equitably involves in all aspects of the research process those who are affected by the issue being studied—community members, organizational representatives, and academic researchers.14 The process assists with a) development of trust and mutual acceptance between researcher and community, b) verification of...

The World Lake Vision and ecohydrology: case study from Wisconsin, USA

The World Lake Vision represents a firm global foundation for lake management across national and cultural boundaries. It provides a set of sustainable use and protection goals for our global water resources. Based on seven principles, the World Lake Vision emphasizes the need for a balance between people, and requires the participation of citizens and policy makers in lake management planning efforts. The recently-completed lake and stream restoration project at Upper Kelly Lake, City of New Berlin, Waukesha County, and Village of Hales Corners, Milwaukee County, Wisconsin (USA) forms a case study illustrating the successful application of these seven principles. Upper Kelly Lake is a small drainage lake in an urbanized location, with a stream inlet that has been historically channelized. Through the efforts of the Kelly Lakes Association, Inc., in addition to local and state governments, lake protection and lake management grants were acquired to fund the stream and wetland restoration project described in this case study.

Applicants' Understanding of Wisconsin's TANF Program and Its Relationship to Other Programs for Low Income Families

This paper uses data from the Milwaukee TANF Applicant Study to examine what a sample of 1,075 TANF applicants from Milwaukee County knew about Wisconsin's TANF program and its relationship to other programs for low-income families. The data suggest that there were significant gaps in knowledge about the program both at the time of application and approximately 18 months later. Although there was a positive relationship between knowledge about the program and participation, even those who participated in the program were frequently confused. This confusion could also account for some of the discrepancies we found when we compared applicant self-reports to State administrative data.

ED Physicians Often Misdiagnose Psychosis

ED Physicians Often Misdiagnose Psychosis

The Financial Collapse Of The Milwaukee Public Museum

The 123-year old Milwaukee Public Museum, which had long been considered to be one of the top natural history museums in the country, found itself in dire financial straights in 2005. The museum had run large deficits for the past three years and had almost entirely eaten through its cash and long-term endowment. In June 2005 it was forced to lay off many of its experienced collections and research staff and had begun the process of preparing to sell off assets that were not a part of the “exhibit experience.” Milwaukee County’s Chief Executive went so far as to suggest that the Museum’s celebrated 700-acre Tirimbina rain forest preserve in Costa Rica should be sold. How did this once renowned organization become a shell of its former self? What financial management and governance mistakes were made, if any, and how could this disaster have been prevented? THE MILWAUKEE PUBLIC MUSEUM CASE

Geographic Distribution of Human Blastomycosis Cases in Milwaukee, Wisconsin, USA: Association with Urban Watersheds

Most studies of endemic blastomycosis and outbreaks have involved rural areas. Case homesites in rural Northern Wisconsin have been associated with waterways and sand soils. ARC-GIS was used to geocode addresses and to observe geographic features of homesites from 45 State-mandated reports of human blastomycosis in urban Milwaukee County, Southeastern Wisconsin 2000-2004. Each case property was directly observed, and houses and duplexes (N = 38) were compared with 151 same-street control homesites. Categorical data was analyzed using a chi-square or Fisher's exact test; continuous variables by Kruskal-Wallis test. One case cluster was seen on Milwaukee's North side where the estimated annual incidence was 2.8/100,000 compared to 0.96/100,000 for the entire county. Cases were less common in the most urbanized watersheds (0.49/100,000/yr) versus Lake Michigan shores (0.85) versus remaining three open watersheds (1.4) [P<0.01]. Case homesites averaged 1067 m to waterways and none were on sand soils. (Comparison is made to a Northern Wisconsin community where case homesites averaged 354 m to waterways, 24/25 were on sand soils and annual incidence was 74/100,000.) No unique features of case homesites were identified in Milwaukee County. In this urban area of Wisconsin, relatively low incidence rates may be explained, in part, by lower density of inland waterways and lack of sand soils, however, blastomycosis cases appear to be associated with open watersheds.

GENDER-BASED MISCOMMUNICATION IN LEGAL DISCOURSE AND ITS IMPACT ON THE CLARITY OF LEGAL LANGUAGE

Language of the law, due to historical, sociological and cultural factors, is often characterized as linguistically obscure and difficult to understand. This is often at odds with the concept that clarity of a message conveyed during court proceedings is crucial to the understanding of the mechanics of the legal processes, as well as their outcome. The present analysis examines structural and lexical features used by men and women litigators in court. This investigation concentrates in particular on those linguistic features used by lawyers that lead to gender-based miscommunication that may adversely influence the outcome of the proceedings. The linguistic features that were examined included the use of syntactically complex utterances and obsolete vocabulary. The data included transcripts of court proceedings and were collected at Milwaukee County Courthouse, Milwaukee, Wisconsin, USA. The analysis revealed that men lawyers use structurally complex language more frequently than women lawyers. The present investigation provides evidence that recognizing different gender specific discourse strategies may significantly improve the clarity of legal language.

The Changing Incidence of Ventricular Fibrillation in Milwaukee, Wisconsin (1992–2002)

Objectives. To investigate the changes in annual incidence andsurvival of out-of-hospital cardiac-etiology arrests of different initial rhythms, particularly ventricular fibrillation (VF) andventricular tachycardia (VT), among adults (> 21 years old) in Milwaukee County between 1992 and2002 andestablish correlations with patient andemergency medical services (EMS) system-dependent factors. Methods. The study was a retrospective, observational study of all adult (> 21-year-old) patients with out-of-hospital cardiac-etiology arrests with identifiable rhythm andresuscitation attempted by the Milwaukee County EMS system from 1992 to 2002. Nine thousand one hundred seventy cases were enrolled. Primary outcome measures were changes in annual incidence of initial cardiac arrest rhythm, with a focus on VF/VT. Secondary outcome measures were changes in survival to hospital admission andhospital discharge for VF andVT. Patient andEMS system factors potentially affecting the outcome measures were identified andmodeled using multivariate logistic regression. Results. The incidence of out-of-hospital VF/VT arrests decreased steadily from 37.1 per 100,000 in 1992 to 19.4 per 100,000 in 2002. While the incidences of pulseless electrical activity andoverall cardiac arrest remained unchanged, the incidence of asystole during the study period increased from 27.3/100,000 to 44.9/100,000. Multivariate regression analyses revealed that age < 80 years, male gender, white race, previous cardiac surgery, andcardiac history were patient-dependent factors predictive of VF/VT. Witnessed arrest, public location, andshorter response time were EMS system-dependent factors predictive of VF/VT. Based on observed trends, none of these correlated factors could explain the decrease in the incidence of VF/VT arrests. Rates of patient survival to hospital admission anddischarge were not significantly changed over time. EMS system factors predictive of survival to admission anddischarge were witnessed arrest, public location, anddecreased number of defibrillations. Prior cardiac surgery andabsence of chronic problems were the only patient factors predictive of survival to hospital admission but were not significantly related to survival to hospital discharge. Conclusions. The incidence of out-of-hospital cardiac arrests in adult patients with presenting rhythm of VF/VT declined, while an increase in asystole occurred. This was not explained by any patient or EMS system-dependent factor. Rate of survival for VF/VT arrest did not significantly change over time. Survival was primarily influenced by EMS system factors andunrelated to patient-dependent factors.

Dreaming of a Decentralized Metropolis: City Planning in Socialist Milwaukee

Dreaming of a Decentralized Metropolis: City Planning in Socialist Milwaukee by John McCarthy Our cities are physically obsolete, and unfitfor the requirements ofwhat we hope soon will bemodern living. Charles Whitnall, 19341 In 1918 the women's editor of one of Milwaukee's largest daily newspapers decided to take a "tour" of the city's poorest neighborhoods and report on their conditions. Accompanied by an official from the city's health department, the editor did not have to venture far from Milwaukee's central business district on Grand Avenue to find urban poverty. Adjacent to downtown on both the Northwest and the South sides were two of the city's most conspicuous slums. The lower Third Ward, east of theMilwaukee River and just south of Grand Avenue, had already been the subject of many stories about how "the other half of the city lived. Alexander Fisher, the health inspector who accompanied the editor on her tour, found most of the housing in the Third Ward "hardly fit for beasts." In a survey of the ward conducted two years earlier, out of the 973 dwellings inspected only 80 had bathtubs, no doubt contributing to the health inspector's characterization of the Third Ward's mostly Italian inhabitants as "filthy."2 The article that followed the editor's tour beseeched Milwaukeeans to see for themselves the squalid conditions of the city's slums. "Clannish foreigners" were crowding one another out of inner-city ghettos; African Americans had replaced Jews in the Sixth Ward neighborhood centered on Seventh and Poplar; Slovaks and Greeks had "chased" the Irish from Tory Hill adjacent to downtown on the west. The family unit was in disarray: "Children run about all day while their 1This epigraph is from "Facing the Future," 1934 folder, Charles Whitnall Papers (hereafter Whitnall Papers), Milwaukee County Historical Society (hereafter MCHS), Milwaukee, Wisconsin. 2 Milwaukee Sentinel, November 26,1916, housing clipping file, Legislative Reference Bureau (hereafter LRB), Milwaukee, Wisconsin. Michigan Historical Review 32-A (Spring 2006): 33-57 ?2006 by Central Michigan University. ISSN 0890-1686 All Rights Reserved. 34 Michigan Historical Review mother is at work." Many of the houses were dubbed "bachelor halls, for they are inhabited by men alone trying to overcome the need of the touch of a woman's hand in homemaking." The women's editor was perhaps most concerned with overcrowding in both the Third and the Sixth wards (adjacent to downtown on the north and west). The headline of her October article warned Milwaukeeans that more than twenty-eight hundred families in the city lived in basement apartments, which mocked the city's reputation as a center of solid Germanic orderliness. The article specifically challenged Milwaukee's elite "limousine class" to drop their Sunday automobile drives in the countryside and spend at least one afternoon immersing themselves in the realities of urban poverty.3 Expos?s of this sort were common in American newspapers and magazines during the Progressive Era. The vivid imagery of Jacob Riis's How the Other Half Uves brought the slum conditions of New York's Lower East Side to a shocked nation. Journalists like Lincoln Steffens had made "muckraking" a cottage industry with tales of both urban corruption and physical decay.4 Because their middle-class audiences had very little personal experience with urban poverty, magazine articles such as these provided shock value just as assuredly as they urgendy called for reform.5 The newspaper story about Milwaukee's slums certainly fit this mold: a dramatic account of poverty and urban despair aimed at the middle and upper classes. What made the article truly distinctive, however, was not its content but its place of publication. It and others like it ran in theMilwaukee leader, the largest daily Socialist newspaper in the country. The Milwaukee leader's frequent articles on Milwaukee's slums provided more than merely tabloid reading. They regularly highlighted the reform efforts of Daniel Hoan, Milwaukee's Socialist mayor from 1916 to 1940.6 Newspaper accounts of slumlike conditions mocked Milwaukee's reputation as a city of homeowners and placed housing squarely at the center of the political agenda. In 1918 Mayor Hoan 3 Milwaukee Leader, October 3,1918, housing...

Pharmacogenomics as Molecular Autopsy for Forensic Toxicology: Genotyping Cytochrome P450 3A4*1B and 3A5*3 for 25 Fentanyl Cases

Pharmacogenomics, the study on genetic contributions to drug action may help in certifying fentanyl toxicity. Fentanyl is used clinically as an adjunct to surgical anesthesia and for chronic pain management. Its toxicity may be partially due to cytochrome P450 (CYP) 3A4*1B and 3A5*3 variant alleles, resulting in variable fentanyl metabolism. In this study, we examined 25 fentanyl-related deaths (22 Caucasians, 1 African-American, and 2 Native-Americans) from the Milwaukee County Medical Examiner's Office and referral cases. Fentanyl and norfentanyl in postmortem blood samples were analyzed by radioimmunoassay and liquid chromatography-mass spectrometry-mass spectrometry. The samples were then genotyped for CYP3A4*1B and 3A5*3 using Pyrosequencing. Genotyping showed: 1 CYP3A4*1B homozygous and CYP3A5*3 heterozygous, 1 compound CYP3A4*1B and CYP3A5*3 heterozygous, 22 CYP3A4*1B wild type and CYP3A5*3 homozygous, and 1 CYP3A5*3 and CYP3A4*1B wild type. CYP variant allelic frequencies of the 25 cases were 6% for CYP3A4*1B and 92% for CYP3A5*3, compared with normal Caucasian CYP3A4*1B, 3-8%, and CYP3A5*3, 85-95%. The mean fentanyl concentration and metabolic ratio of fentanyl to norfentanyl of the 2 cases with CYP3A4*1B and CYP3A5*3 variants were 12.8 and 1.4 microg/L, respectively, lower than those of 22 cases with wild type CYP3A4*1B and CYP3A5*3 homozygous variants, 16.7 and 7.3 microg/L, respectively. The postmortem/in vivo data provided the first scientific evidence that CYP3A5 is involved in the fentanyl metabolism, and homozygous CYP3A5 *3 causes impaired metabolism of fentanyl, and genotyping CYP3A4*1B and 3A5*3 variants may help to certify the fentanyl toxicity.

Policy Performance and Brownfield Redevelopment in Milwaukee, Wisconsin*

The redevelopment of brownfield sites has become a central focus of government efforts aimed at developing and revitalizing urban areas in the U.S. This article examines brownfield redevelopment efforts in Milwaukee County, Wisconsin, which gained momentum in the mid-1990s, in order to determine how Milwaukee is performing in terms of redevelopment activities, what the effects of government support of such activities have been, and how performance outcomes are currently being measured. Through an examination of government data and interviews with key stakeholders, the Milwaukee case reveals that redevelopment is indeed progressing well as government becomes more effective at tackling the barriers to private-sector redevelopment. However, progress in redeveloping brownfields is still being measured primarily in terms of economic development outcomes rather than in terms of the broader social, economic, and environmental objectives that both policy makers and private-sector stakeholders associate with such redevelopment. *The research for this study was funded by the University of Wisconsin-Milwaukee Consortium for Economic Opportunity, through its faculty fellowship program, for which I express my sincere gratitude. I would also like to thank the interviewees, the government officials who provided data, my project assistant Josh Lang, the anonymous reviewers, and the editor.

A Critical Shortage of Surgical Technologists Creates Collaboration Between Rivals

TWO RIVAL HEALTH CARE SYSTEMS collaborated to meet an increasing demand for surgical technologists in the Milwaukee area by developing and implementing a nine-month surgical technologist program. THIS UNIQUE APPROACH included using grant funds from the Private Industry Council of Milwaukee County to help fulfill local health care organizations' commitment to employee development and adequate staffing. TWENTY-ONE SURGICAL TECHNOLOGISTS graduated from the program and successfully began health care careers; three of the graduates are continuing their education in nursing school.

The use and abuse of psychostimulants.

1. Susan B Gock, MS MT(ASCP)[⇑][1] 1. is Technical Director, Milwaukee County Medical Examiner's Toxicology Laboratory, Milwaukee WI 2. Victor A Skrinska, PhD DABCC 1. is Professor and Chair, University of Alabama at Birmingham, Birmingham AL 1. Address for correspondence: Susan B Gock MS MT(ASCP), Forensic Laboratory Technical Director, Milwaukee County Medical Examiner's Office, 933 West Highland Ave, Milwaukee WI 53233. (414)-223-1228. sgock{at}milwcnty.com. Drug use has become a significant medical and social problem in the United States. Toxicological analysis of biological specimens from individuals is generally accepted to be the most objective method for determining drug use and abuse. As a science, forensic toxicology deals with the medico-legal implications of drug use, misuse, and abuse. This may include the following: criminal penalties imposed for the distribution, possession, and use of illicit drugs; assessment of drug impairment in human performance (behavioral) toxicology; assessment of drug toxicity as a contributing factor in the cause and manner of death in postmortem forensic toxicology cases; or detection of drug use in workplace drug testing programs. Psychostimulants include a diverse class of drugs exhibiting central nervous system stimulant properties, and have a high abuse potential. Drugs in this class include illicit drugs, prescription medications, over the counter (OTC) preparations, and dietary supplements. Clinical indications for therapeutic use include treatment of narcolepsy, attention deficit disorder, and as an appetite suppressant in the treatment of obesity. Pharmacological effects of psychostimulant drugs include the ability to increase alertness, relieve fatigue, decrease appetite, elevate mood, increase confidence, and produce euphoria. Abuse of psychostimulant drugs may lead to tolerance that is exhibited by the need of higher doses of the drug to produce the same desired effects. Consequently, users may try to intensify the drug's positive effects by increasing the drug dosage, taking it more frequently, or changing the route of administration leading to the possibility of drug abuse, misuse, or toxicity. The… ABBREVIATIONS: DAWN = Drug Abuse Warning Network; ED = emergency department; MDA = methylenedioxyamphetamine; MDMA = methylenedioxymethamphetamine; OTC = over the counter. [1]: #corresp-1

Understanding Population Segregation from Landsat ETM+ Imagery: A Geographically Weighted Regression Approach

This study attempts to understand population segregation issues in Milwaukee County, Wisconsin utilizing remote sensing and regression technologies. Population segregation was measured with a local segregation index Di based on the theory of the index of dissimilarity. Remote sensing information was extracted from a Landsat ETM+ image through spectral mixture analysis, unsupervised classification, and texture analysis. Global ordinary least squares (OLS) regression and geographically weighted regression (GWR) analyses were applied to explore the relationships between population segregation and remote sensing variables. Results indicate that remote sensing information has the potential to increase our understanding of socio-cultural issues such as population segregation.

An Evaluation of Alternative Forecasting Methods to Recreation Visitation

This study examines the advantages and disadvantages of basic, intermediate, and advanced methods for visitor use forecasting where seasonality and limited data are characteristics of the estimation problem. The monthly use rates at the Milwaukee County Zoo, Wisconsin are used to illustrate the seasonal time series techniques. Forecasting methods include the Naive 1, Naive 2, single moving average (SMA) with the classical decomposition procedure, single exponential smoothing (SES), double exponential smoothing (DES), Winter's, and the seasonal autoregressive integrated moving average (SARIMA). The variation in visitor rates over the years makes the visitation trend for the Milwaukee County Zoo appealing in this empirical application. The series ranges from January 1981 through December 1999, a total of 228 months. The last 12, 24, or 60 months of those data are excluded from the original analysis, and used to evaluate the various methods. SARIMA and SMA with the classical decomposition procedure are found to be roughly equivalent in performance, as judged by modified mean absolute percentage error (MAPE) and modified root mean square percentage error (RMSPE) values of a longer estimation period with shorter period ahead forecasts. This study also finds that the SMA with classical decomposition method is more accurate than other techniques when a shorter estimation period with longer period ahead forecasts are included. While this study may not speak to all users of leisure related data, it serves as a comparative reference for those who seek guidance in deciding among a set of forecasting tools.

Pharmacogenomics as an Aspect of Molecular Autopsy for Forensic Pathology/Toxicology: Does Genotyping CYP 2D6 Serve as an Adjunct for Certifying Methadone Toxicity?

Pharmacogenomics, applied as an aspect of molecular autopsy, may be used as an adjunct for certifying methadone fatalities. Methadone is metabolized by cytochrome P-450 (CYP) 1A2, 3A4, and 2D6. We hypothesized that methadone toxicity may be partially due to CYP 2D6 *3, *4, and *5 variant alleles, resulting in poor drug metabolism. A retrospective analysis was performed on covariables and risk factors of 21 methadone cases from the Milwaukee County Medical Examiner's Office (1998-2000). PCR genotyping showed: one heterozygous for 2D6*3, two homozygous for 2D6*4, five heterozygous for 2D6*4, and one heterozygous for both 2D6*3 and *4. This limited number of cases showed that the prevalence of poor metabolizer was higher but not significantly different from that of a control group (n = 23) (P > 0.05, Fisher Exact Test). Thus, CYP 2D6 mutations may not yet be directly associated with methadone toxicity. However, pharmacogenomics, complementing other case findings, served as an adjunct in interpreting methadone toxicity of poor and intermediate metabolizers.

Observational study of the extent of driving while suspended for alcohol impaired driving

Objective: To determine the proportion of first time driving while alcohol impaired (DWI) offenders who drive while their driver’s license is suspended. Design: Systematic, unobtrusive observations were conducted by surveillance...