Search PubMed⌕ Search

Biomedical subjects

A M Best

Publications and source records attributed to A M Best.

At least 37 records · Page 2Linked to original sources
PubMed1997

Soluble E-selectin levels in sepsis and critical illness. Correlation with infection and hemodynamic dysfunction.

E-selectin, an early mediator of leukocyte-endothelial adhesion, is expressed on activated endothelium. Soluble E-selectin is present in the supernatant of cytokine-activated endothelial cells and elevated serum levels are found in a variety of inflammatory conditions. We documented elevated E-selectin serum levels in 119 critically ill medical ICU patients (log transformed mean E-selectin level, measured by ELISA, was 5.28 ng/ml) compared to normal volunteers (1 ng/ml). Forty-three patients with culture-positive sepsis had higher (p < 0.05) E-selectin levels (15.39 ng/ml) than 24 patients with culture-negative sepsis (4.87 ng/ml), 44 with noninfectious SIRS (2.33 ng/ml), and eight without SIRS (1.97 ng/ml). E-selectin levels related strongly to the degree of hemodynamic compromise (p < 0.0001). Further analysis demonstrated microbiological status and hemodynamic status to be independent variables related to E-selectin level. Day 1 E-selectin levels correlated positively with peak organ failure score over the course of ICU hospitalization (r = 0.30, p = 0.001) and were higher (p < 0.05) for nonsurvivor (10.61 ng/ml, n = 26) than survivors (4.35 ng/ml, n = 93). We conclude that soluble E-selectin levels are higher in serum of patients with microbiologically documented sepsis than in other critically ill medical ICU patients. Day 1 E-selectin levels correlate highly with hemodynamic compromise and modestly with subsequent organ dysfunction and survival.

APACHE↗
PubMed1996

Prevention of child-to-mother transmission of cytomegalovirus by changing behaviors: a randomized controlled trial.

BACKGROUND: To determine whether a behavioral prevention approach reduces child-to-parent transmission of cytomegalovirus. METHODS: Subjects were seronegative mothers whose child was less than 36 months of age and was shedding cytomegalovirus. Nonpregnant women were randomly assigned to three groups. Mothers in the education group (E) were given instructions about protective behaviors (frequent hand washing, wearing latex gloves) and risky behaviors to avoid (intimate contact with the child). Disposable diapers, liquid soap and latex gloves were provided. During biweekly home visits glove and soap use were monitored for an indirect objective measure of adherence to the protective behaviors. Throughout the study mothers self-reported the frequency they engaged in protective and risky behaviors. In addition to the procedures for Group E the adherence and education group (A) also received social reinforcement for adherence and problem solving for any perceived problems with the behavioral recommendations. The control group (C) received no intervention. A fourth group of pregnant women received an intervention equivalent to that of the education group. RESULTS: Eight of 17 women in Group C and 4 of 11 women in Group E seroconverted. For both E and Group C the average time from enrollment to infection was 4 months (range, 2 to 7 months). Two of 8 women in Group A seroconverted (1 at 3 months and 1 at 8 months). None of 14 pregnant women observed for an average of 8.4 months during pregnancy seroconverted. CONCLUSIONS: These results suggest that intervention for pregnant women is effective because pregnant women will perceive a higher risk and be more motivated to adhere to recommendations than nonpregnant women.

Child, Preschool↗
PubMed1996

Professionals' perceptions of psychotropic medication in residential facilities for individuals with mental retardation.

Professional staff in four state facilities for individuals with mental retardation were surveyed to determine their perceptions, knowledge and opinions regarding the use of psychotropic medication. A large majority of the 377 respondents indicated that the physicians in their facilities were primarily responsible for medication-related decisions. Under ideal conditions, however, all professional staff and parents were seen as having a greater influence in the decision-making process. Aggression, delusions and hallucinations, self-injury, other psychiatric disorders, and anxiety were rated as disorders most likely to result in medication therapy. Behaviour modification was viewed as a suitable alternative to drug treatment for acting out and aggression. The professionals indicated that behavioural observation was the most influential assessment technique in current usage, followed by global impressions and informal diaries. Over 80% of the respondents perceived their preservice and inservice training on issues related to the use of psychotropic medication to treat behaviour problems as inadequate, with 96% of them desiring continuing education. These findings were compared to data from similar studies of populations with other disabilities, and suggestions for modifications in the current decision-making processes related to the use of psychotropic medication in institutionalized individuals with mental retardation are discussed.

Adolescent↗
PubMed1995

Immunity induced by primary human cytomegalovirus infection protects against secondary infection among women of childbearing age.

To determine if immunity to human cytomegalovirus (HCMV) protects women from acquiring HCMV from their children, a blinded, randomized protocol was used to monitor seronegative women who received placebo or Towne vaccine (approximately 500 pfu) and seropositive women. Each group was similar for mean maternal (33 years) and child age (18 months) and duration of viral shedding by the child (15 months). Among 19 placebo recipients, 9 developed primary infection; 8 of 19 vaccines but only 3 of 42 naturally seropositive subjects had evidence of acquiring HCMV from their child. Wild type infection and Towne vaccine induced similar mean lymphoproliferative responses to HCMV antigens, but one dose of Towne vaccine produced mean neutralizing titers 10- to 20-fold lower than those after wild type infection. Thus, a vaccine that induces immune responses equal to those induced by wild type virus may protect healthy women from acquiring HCMV from their children.

Adult↗
PubMed1994

Time-domain ultrasonography during pregnancy.

Time-domain ultrasonography is an alternative to Doppler analysis of blood flow direction and velocity. The technique uses timing information between successive echo pulses to measure flow velocities directly through a color display map. Volume flow quantification also can be achieved by combining time-domain methods with M-mode ultrasonography. This report describes our preliminary experiences with fetal vascular imaging by time-domain ultrasonography, compares Doppler peak velocity correlation to time-domain sonography, and examines the in vitro accuracy of time-domain sonography combined with M-mode volume flow measurements. Excellent agreement was found between peak Doppler velocity measurements and time-domain ultrasonography for a variety of maternal and fetal vessels (N = 29). Close volume-flow correlation was observed between a flow pump and time-domain ultrasonography under constant and pulsatile conditions. Time-domain ultrasonography appears to be a useful alternative to Doppler techniques for imaging small fetal vessels and also may provide the basis for accurate volume flow measurements during pregnancy.

Blood Circulation↗
PubMed1993

Risk of human parvovirus B19 infections among school and hospital employees during endemic periods.

Because human parvovirus B19 (B19) infections are common in children, and maternal infection of pregnant women may cause fetal death, risk factors for B19 infections for hospital and school employees were identified during an endemic period. By serologic testing, 2730 employees of 135 schools in three school systems and 751 employees of a hospital were monitored. Of these, 60% were initially seropositive. After adjusting for age, race, and gender, risk factors for seropositivity were contact with children 5-18 years old at home (odds ratio [OR] = 1.2), at work (OR = 1.2), and employment in elementary schools in school system 2 (OR = 1.4). Over 42 months, 1 of 198 susceptible hospital employees seroconverted versus 62 of 927 school employees. Four factors associated with seroconversion were employment at elementary schools in system 2, contact with children 5-11 years old at home or with children 5-18 years old at work, and age < 30 years. Those in daily contact with school-age children had a fivefold increased annual occupational risk for B19 infection.

Adult↗
PubMed1993

The influence of race and gender on periodontal microflora.

Previous studies have demonstrated that demographic characteristics of subject populations influence both the incidence of periodontal diseases and various aspects of host responses to periodontal bacteria. In this study we analyzed the components of the subgingival microflora from individuals with adult periodontitis, early onset periodontitis, gingivitis, and periodontal health as a function of gender and race (black and white). Clinical categories were analyzed individually so that there were no differences in the clinical characteristics of the sampled sites. No significant differences were noted in the subgingival microflora between males and females. When either the first two bacterial samples from each subject or all bacterial samples taken from each subject were included in the analysis, it was found that Porphyromonas gingivalis was more significantly associated with black subjects in the adult periodontitis group. When all samples were considered in the analysis, it was found that Peptostreptococcus anaerobius was associated with black subjects in the adult periodontitis group, while Fusobacterium nucleatum was associated with white subjects in both the adult periodontitis and early onset periodontitis groups. Thus a limited number of important bacterial components of the subgingival microflora are influenced by the race and diagnosis of the subject group.

Adolescent↗
PubMed1991

States' use of transfer of custody as a requirement for providing services to emotionally disturbed children.

Survey data were collected from 45 states on the extent to which transfer of custody was required for families to obtain intensive services for children with serious emotional disturbances. In 28 of the states (62 percent), at least one agency serving children reported using transfer of custody as a requisite for obtaining services. Corrections and social service agencies were most likely to require transfer of custody, followed by youth services and mental health agencies. Most agencies that required transfer of custody lacked statutes or regulations governing two of the three types of transfers used. States that required transfer of custody tended to be less populated and to have a lower per capita income than states that did not. The major factor contributing to use of transfer of custody, the authors conclude, is the absence of an adequate system of services designed specifically for children with serious emotional disturbances.

Affective Symptoms↗
PubMed1990

Characteristics of children and adolescents in a psychiatric hospital and a corrections facility.

Popular opinion holds that youngsters in corrections programs are delinquents in need of reform, whereas youngsters in psychiatric settings have mental health problems and need therapy. Yet some literature suggests that youth in the two settings may not differ greatly in their mental health status. The authors compared demographic, emotional, and behavioral characteristics of youngsters placed in public psychiatric hospital and corrections settings, and they found few differences. Child Behavior Checklist scores for social competence and total problems were high and quite similar for youngsters in the two settings. White children scored significantly worse than black children on Child Behavior Checklist Internalizing, Externalizing, and total problems in corrections settings but not in the psychiatric hospital. Moreover, race was the only variable that predicted the site in which youth were placed. The findings suggest a need to study (1) the mental health needs of youngsters in nonmental health settings and (2) the procedures by which youth are assigned to service settings.

Adolescent↗
PubMed1990

Reliability of attachment loss measurements in a longitudinal clinical trial.

In order to appropriately carry out a longitudinal assessment of periodontal attachment loss in individuals with untreated periodontitis, reliable criteria for determining "real" changes in attachment level (AL) are required. In the present study, 25 subjects were to be examined every 2 months for up to 2 years to determine changes in AL and to relate clinical and laboratory criteria to such changes. Trained examiners for the study underwent calibration trials to determine inter-examiner and intra-examiner reliability both before the study and at intervals during the study. It was found that AL measurements were in agreement within 2 mm more than 95% of the time. The calibration trials provided an estimate of the error in attachment loss measurements, since no "real" attachment loss had occurred. From estimates of measurement error, the probability of false positive changes were determined. It was found that acceptable false positive rates (less than 5%) could be achieved if 2 examiners each detected 3 mm change at a given site or if 2 examiners each detected 2 mm change at a site and verified that this change persisted at a subsequent examination. The results of the longitudinal trial were then compared to the probability estimates calculated from the calibration trials. It was found that probabilities of AL changes detected during the longitudinal trial for less stringent conditions than described above (e.g., single examiner, 2 examiners unconfirmed) were similar to to previously estimated false positive rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Current trends in the treatment of maxillofacial injuries in the United States.

This report presents the results of a 1987 survey of members of the American Association of Oral and Maxillofacial Surgeons used to assess current national and regional trends in the management of maxillofacial trauma. Comparisons are also made with a similar British survey done in 1980. The results show differences between the two countries as well as regional differences within the United States. The significance of these findings are discussed.

Adult↗
PubMed1988

Change in attachment level.

Attachment level or pocket depth measurements are used to detect change in periodontal attachment. However, measurement error limits their usefulness for this purpose. The aims of this study are twofold. The first aim was to test the assumption, used in previous reports of measurement error, that attachment level measurements are normally distributed. The second aim was to estimate error rates encountered when assessing periodontal attachment level change with attachment level or pocket depth measurements. Two simulation methods are compared in their ability to reproduce the distribution of differences in replicated measurements. A simulation method based on a normal distribution was not able to reproduce the actual distribution of differences between replicate measurements. In contrast simulations based on resampling recreated the distribution of differences in replicated attachment level measurements. Due to the inability of simulations based on the normal distribution to reproduce the distribution of differences in replicated measurements, simulations based on the resampling procedure were used to estimate error rates. Determining change in attachment level or pocket depth by either single or paired measurements resulted in low Type I error rates for both single and paired measurements. For single measurements of attachment level, the Type I error rate was 0.0074 for a 3-mm change. Paired measurements of attachment level had a Type I error rate of 0.0014 for a 3-mm change. However, false-positive rates were found to be much higher. For single measurements of attachment level, the false-positive rate was 0.32 for a 3-mm change.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic Errors↗
PubMed1987

Bacteriology of human gingivitis.

The subgingival bacterial floras of naturally occurring gingivitis in adults and children were characterized and compared with the floras of other periodontal conditions previously studied. The composition of the gingivitis floras was found to be distinct from that of floras associated with health or with moderate, severe, or juvenile periodontitis. There were no major differences between the floras of naturally-occurring gingivitis and the floras of the human experimental gingivitis model. Data indicated that the flora of healthy sites within a mouth is influenced by the number of inflamed sites, which argues against independence of sites bacteriologically. Proportions of ten bacterial species increased in both gingivitis and periodontitis, as compared with health, in both adults and children. These species were found in both affected and unaffected sites of people with gingivitis. The numbers of five other cultivable species and the "large treponeme", which was not cultivated, increased in gingivitis and periodontitis of adults only. Significant differences in non-spirochetal floras between children and adults were not found, although they were in the experimental gingivitis model studied previously. Cultivable spirochetes did differ between children and adults. Children had fewer samples positive for spirochetes, and children's positive samples contained greater proportions of T. socranskii subsp. paredis. Some species that predominate in periodontitis, but which are absent from healthy gingivae, were found as a small percentage of the flora in gingivitis. This suggests that increased serum and blood in the gingival crevice encourage species that relate to periodontitis.

Adult↗