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Papers by martin lee

Journal of the Chinese Institute of Engineers, 2007

The latest computer CPUs require the use of DC power converters with AVP. Three commonly-used AVP... more The latest computer CPUs require the use of DC power converters with AVP. Three commonly-used AVP control schemes were compared using small-signal loop gain analysis. From the comparison results emerges the fourth scheme proposed recently: the Native current-mode AVP scheme (NAVP). NAVP provides inherent phase current balancing, cycle-to-cycle protection, large stability margin, good line regulation, and constant output impedance. It compares favorably against the other three schemes.

Multicenter Trial to Evaluate the Safety and Potential Efficacy of Pooled Human Fibrin Sealant for the Treatment of Burn Wounds

The Journal of Trauma: Injury, Infection, and Critical Care, 1999

The primary purpose of this multicenter study was to evaluate the safety and potential efficacy o... more The primary purpose of this multicenter study was to evaluate the safety and potential efficacy of a solvent/detergent-treated commercial fibrin sealant (human) for topical hemostasis in skin grafting. The study involved a prospective evaluation of changes in viral titers in patients with burns less than 15% after treatment with fibrin sealant (human). Each patient served as his/her own control for an unblinded, randomized comparison of donor site hemostasis and healing. Preoperative serum was obtained to screen for viral titers. At autografting, the recipient site and one of two randomly chosen donor sites were treated with fibrin sealant (human). The use of other hemostatic agents, including epinephrine was prohibited. Each donor site was covered with gauze to collect blood for estimation of the relative amount of bleeding. The healing of the graft and donor sites was observed. Viral titers and wounds were checked monthly for 6 months, and at 9 and 12 months postoperatively. Viral titers for human immunodeficiency virus; hepatitis A, B, and C; Epstein-Barr virus; and cytomegalovirus were obtained before and after treatment. Of 47 patients, 34 completed the full year of observation. After treatment, there were no seroconversions to any of the aforementioned viruses. Bleeding at the recipient site appeared well controlled with fibrin sealant (human). Although investigators felt that fibrin sealant (human) improved donor site hemostasis, differences in hemoglobin measurements of blood-soaked dressings failed to reach significance. No differences were noted with regard to acceleration of donor site healing, graft take, or scar maturation at the two groups of donor sites. Anecdotally, the maturation of the recipient site appeared to be accelerated. Fibrin sealant (human) is safe for use during excision and grafting, and its topical hemostatic potential needs to be examined in patients with larger burns. Its role in scar maturation also needs to be investigated.

Compensator design for adaptive voltage positioning (AVP) for multiphase VRMs

2006 37th IEEE Power Electronics Specialists Conference

AbstractIn an AVP scheme, feedback compensation design is crucial to achieve a desirable constan... more AbstractIn an AVP scheme, feedback compensation design is crucial to achieve a desirable constant converter output impedance while maintaining converter stability. The model proposed and the analysis given provides insightful view of the interaction of the two performances. ...

Transfusion, 2005

BACKGROUND: Photochemical treatment (PCT) with amotosalen HCl (S‐59) was developed to inactivate ... more BACKGROUND: Photochemical treatment (PCT) with amotosalen HCl (S‐59) was developed to inactivate pathogens and white blood cells in plasma (PCT‐FFP) used for transfusion support.STUDY DESIGN AND METHODS: An open‐label, multicenter trial was conducted in patients with congenital coagulation factor deficiencies (factors [F]I, FII, FV, FVII, FX, FXI, and FXIII and protein C) to measure the kinetics of specific coagulation factors, hemostatic efficacy, and safety of PCT‐FFP. Posttransfusion prothrombin time (PT), partial thromboplastin time (PTT), and clinical hemostasis were evaluated before and after PCT‐FFP transfusions.RESULTS: Thirty‐four patients received 107 transfusions of PCT‐FFP for kinetic studies or therapeutic indications (mean dose, 12.8 ± 8.5 mL/kg). Incremental factor recoveries ranged from 0.9 to 2.4 IU per dL per IU per kg (FII, FV, FVII, FX, FXI, and protein C). Mean pretransfusion PT (20.7 ± 22.2 sec) corrected after PCT‐FFP (13.8 ± 2.4 sec, p < 0.001). Mean pretr...

Transfusion, 2002

To date, no clinical trials have characterized FFP infusion efficacy, and infusion still carries ... more To date, no clinical trials have characterized FFP infusion efficacy, and infusion still carries infectious risk. This single-blinded crossover study compared postinfusion kinetics of FVII in photochemically treated FFP to standard FFP. STUDY DESIGN AND METHODS: Subjects donated plasma by apheresis. Half of the collected plasma was treated with the psoralen amotosalen hydrochloride (S-59) and UVA light, and half were prepared as standard plasma. Subjects received warfarin over 4 days to lower FVII levels. On Day 4, subjects received 1 L of either treated or standard FFP. After 2 weeks, subjects underwent a regimen identical to that with the other type of FFP. RESULTS: After warfarin ingestion, the mean FVII concentration was 0.33 IU per mL. Both types of FFP exhibited comparable FVII kinetics, with a mean peak increment of 0.10 to 0.12 IU per mL occurring at the end of infusion. The effect disappeared after 8 hours. DISCUSSION: Study data of warfarin-treated healthy volunteers demonstrate that psoralen plus UV-treated FFP provides an equivalent in vivo coagulation response to control plasma. A 1-L dose of FFP in adults may provide an initial increment of 0.10 IU per mL of FVII. In the absence of bleeding, FVII levels return to baseline after 8 hours.

Movement Disorders, 2007

Because Parkinson's disease (PD) has multiple neurological symptoms and often complex treatments,... more Because Parkinson's disease (PD) has multiple neurological symptoms and often complex treatments, the quality of PD care may be higher when a specialist is involved. We examined the medical records, from 1998 to 2004, of 401 Los Angeles veterans with Parkinson's disease to determine whether care met key indicators of PD care quality. All care following a visit to a movement-disorder specialist or general neurologist was classified as specialty care. We compared adherence to each indicator by level of specialist involvement through logistic regression models. Over the study period, 10 indicators of PD care quality were triggered 2,227 times. Overall, movement disorder specialist involvement (78%) was associated with higher adherence to indicators than did general neurologist involvement (70%, P ϭ 0.006) and nonneurologist involvement (52%, P Ͻ 0.001). The differences between movement disorder specialist and nonneurologist involvement were especially large for four indicators: treatment of wearing-off, assessments of falls, depression, and hallucinations. There is significant room for improving aspects of PD care quality among patients who do not have the involvement of a specialist. Quality of care interventions should involve specialists in management of motor symptoms and incorporate methods for routine assessment of nonmotor PD symptoms.

Effect of a Dementia Care Management Intervention on Primary Care Provider Knowledge, Attitudes, and Perceptions of Quality of Care

Journal of the American Geriatrics Society, 2006

OBJECTIVES: To evaluate the effect of a multicomponent dementia care management program on primar... more OBJECTIVES: To evaluate the effect of a multicomponent dementia care management program on primary care provider knowledge, attitudes, and perceptions of quality of dementia care.DESIGN: A clinic‐level randomized, controlled trial of a comprehensive care management program for patients with dementia and their nonprofessional caregivers. The program included provider education and protocols for care managers to communicate with patients' medical providers.SETTING: Sixteen clinics (eight intervention, eight usual care) in three healthcare systems in San Diego, California.PARTICIPANTS: Two hundred thirty‐two medical providers; 129 from eight intervention clinics; 103 from eight usual‐care clinics.MEASUREMENTS: Providers were surveyed 9 months after intervention onset on knowledge (five items on four topics), attitudes about dementia (three items), and perception of quality of dementia care in their practice setting (three items). Multivariable linear and logistic regression models ...

Journal of Burn Care & Rehabilitation, 1997

Journal of Allergy and Clinical Immunology, 2014

RATIONALE: Non-adherence to asthma controller medications is a significant cause of morbidity and... more RATIONALE: Non-adherence to asthma controller medications is a significant cause of morbidity and urgent health care utilization. Assessment regarding documentation of adherence during physician encounters has not previously been reported. METHODS: We performed a retrospective review of the electronic medical record(EMR) for all patients ages 2-18 with encounters at a tertiary care pediatric academic referral center with primary diagnosis 493.xx during September 2012. Site of encounter was identified as: urgent care(UC), emergency department(ED), inpatient(IP), pulmonary and allergy/immunology clinics(SP), and primary care(PCC). Documentation of adherence was defined by specific mention regarding patient use or disuse of controller medication at any part of the EMR for that unique encounter. RESULTS: 62%(N5676/1090) of EMR encounters reviewed had at least one controller medication prescribed at the time of encounter. Of the 676 encounters, documentation of adherence was observed in 78%(N5525). UC536%(31/87) and ED558%(54/93) had significantly less documentation of adherence compared with IP592%(48/52), SP587%(244/282), and PCC591%(148/162)p<0.05. Use of an EMR asthma encounter template560%(407/676) was associated with a significant increase in documentation of adherence597%(394/407) vs. 49%(131/269)p<0.05. An EMR template was used less frequently in UC516%(14/87) and ED534%(32/93) compared with IP577%(40/52), SP565%(182/282), and PCC586%(139/162). CONCLUSIONS: Documentation of adherence at sites of urgent health care utilization (UC/ED) occurred less frequently compared with other sites of asthma care. Utilization of a prepopulated EMR template was associated with a significantly higher rate of adherence documentation. The use of an EMR template within the UC/ED setting could offer an important opportunity to address non-adherence with asthma controller medications.

Implementation Science, 2011

Background: Meta-analyses show collaborative care models (CCMs) with nurse care management are ef... more Background: Meta-analyses show collaborative care models (CCMs) with nurse care management are effective for improving primary care for depression. This study aimed to develop CCM approaches that could be sustained and spread within Veterans Affairs (VA). Evidence-based quality improvement (EBQI) uses QI approaches within a research/clinical partnership to redesign care. The study used EBQI methods for CCM redesign, tested the effectiveness of the locally adapted model as implemented, and assessed the contextual factors shaping intervention effectiveness. Methods: The study intervention is EBQI as applied to CCM implementation. The study uses a cluster randomized design as a formative evaluation tool to test and improve the effectiveness of the redesign process, with seven intervention and three non-intervention VA primary care practices in five different states. The primary study outcome is patient antidepressant use. The context evaluation is descriptive and uses subgroup analysis. The primary context evaluation measure is naturalistic primary care clinician (PCC) predilection to adopt CCM. For the randomized evaluation, trained telephone research interviewers enrolled consecutive primary care patients with major depression in the evaluation, referred enrolled patients in intervention practices to the implemented CCM, and re-surveyed at seven months. Results: Interviewers enrolled 288 CCM site and 258 non-CCM site patients. Enrolled intervention site patients were more likely to receive appropriate antidepressant care (66% versus 43%, p = 0.01), but showed no significant difference in symptom improvement compared to usual care. In terms of context, only 40% of enrolled patients received complete care management per protocol. PCC predilection to adopt CCM had substantial effects on patient participation, with patients belonging to early adopter clinicians completing adequate care manager followup significantly more often than patients of clinicians with low predilection to adopt CCM (74% versus 48%%, p = 0.003). Conclusions: Depression CCM designed and implemented by primary care practices using EBQI improved antidepressant initiation. Combining QI methods with a randomized evaluation proved challenging, but enabled new insights into the process of translating research-based CCM into practice. Future research on the effects of PCC attitudes and skills on CCM results, as well as on enhancing the link between improved antidepressant use and symptom outcomes, is needed.

Annals of Allergy, Asthma & Immunology, 2012

Background: This study used accepted asthma metrics and pharmaceutical claim data to develop a ne... more Background: This study used accepted asthma metrics and pharmaceutical claim data to develop a new asthma metric as a possible surrogate for spirometry and to better assess asthma control. Objective: To develop and validate a new asthma metric called the Rescue Index (RI) based on ␤ 2-agonist dispensings and to test the feasibility of a multivariate model to construct a global asthma metric called the Asthma Control Index (ACI). Methods: This prospective, observational, multicenter cohort study was conducted at the Naval Medical Center San Diego (NMCSD) and at the Phoenix VA Health Care System (PVAHCS). Pharmacy claim data were correlated with the ACT, Medication Adherence Report Scale for Asthma (MARS-A), and spirometry using univariate and multivariate analyses. Results: A total of 263 individuals enrolled in the study, and 95 (PVAHCS) and 156 (NMCSD) individuals completed the study. In the PVAHCS, the ACT correlated with the asthma medication ratio (AMR) (ϭ 0.37, P Ͻ .001) and inversely correlated with the RI (ϭ Ϫ0.33, P ϭ .001), the RI inversely correlated with forced expiratory volume in 1 second (FEV 1) (ϭ Ϫ0.22, P ϭ .03) and the FEV 1 to forced vital capacity ratio (ϭ 0.22, P ϭ .03). In the NMCSD population, the ACT correlated with the MARS-A (ϭ 0.23, P ϭ .006), FEV 1 did not correlate with ACT (ϭ 0.09, P ϭ .25) or MARS-A (ϭ 0.16, P ϭ .047) but directly correlated with the RI (ϭ 0.19, P ϭ .03). The AMR was strongly inversely correlated with RI in both populations (Ϫ0.74, P Ͻ .001 in the PVAHCS group and Ϫ0.78, P Ͻ .001 in the NMCSD group). When multivariate models were applied to the NMCSD and PVAHCS groups, the combination of RI and MARS-A was the best predictor of spirometry. Conclusion: The RI shows promise as a new asthma metric because it correlated with AMR in both cohorts. However, because RI correlated with adult spirometry and ACT only, further validation studies are needed before RI may be included in an ACI metric.

New Perspectives Quarterly, 2008

Pondering all the failed revolutions throughout the Third World over the last 50 years, the liter... more Pondering all the failed revolutions throughout the Third World over the last 50 years, the literary journalist Ryszard Kapuscinski once offered this summary lesson of the 20th century:There are no shortcuts in history. Using force to try to accelerate social progress and political change before its time will fail. It was this failure of revolution from Africa to Latin America to the collapse of the Soviet Union itself that led Francis Fukuyama to declare the "end of history"-the exhaustion of all historical alternatives to free markets and liberal democracy. Seeking to speed up the "end of history" where it hadn't yet arrived, the neo-Wilsonian conservatives behind the Bush Administration's Iraq policy sought to bring WINTER 2008 46 ZBIGNIEW BRZEZINSKI