Biomedical subjects

B A McIntosh

Publications and source records attributed to B A McIntosh.

6 recordsLinked to original sources

PubMed2001

Do race and gender influence the use of invasive procedures?

OBJECTIVE: To assess the influence of race and gender influence on the use of invasive procedures in patients with acute myocardial infarction (AMI) in community hospitals. DESIGN: Prospective, observational. SETTING: Five mid-Michigan community hospitals. PATIENTS: All patients (838) identified with AMI between January 1994 and April 1995 in 1 of these hospitals. MEASUREMENTS AND MAIN RESULTS: After adjusting for age, hospital of admission, insurance type, severity of AMI, and comorbidity, using white men as the reference group, the rate of being offered cardiac catheterization (CC) was 0.88 (95% confidence interval [95% CI], 0.60 to 1.29) for white women; 0.79 (95% CI, 0.41 to 1.50) for black men; and 1.14 (95% CI, 0.53 to 2.45)for black women. Among patients who underwent CC, after also adjusting for coronary artery anatomy, the rate of being offered angioplasty, using white men as the reference group, was 1.22 (95% CI, 0.75 to 1.98) for white women; 0.61 (5% CI, 0.29 to 1.28, P =.192) for black men; and 0.40 (95% CI, 0.14 to 1.13) for black women The adjusted rate of being offered bypass surgery was 0.47 (95% CI, 0.24 to 0.89) for white women; 0.36 (95% CI, 0.12 to 1.06) for black men; and 0.37 (95% CI, 0.11 to 1.28)for black women. CONCLUSIONS: Our study shows that white women are less likely than white men to be offered bypass surgery after AMI. Although black men and women with AMI are less likely than white men to be offered percutaneous transluminal coronary angioplasty or coronary artery bypass grafting in both unadjusted and adjusted analyses, these findings did not reach statistical significance. Our study is limited in power due to the small number of blacks in the sample.

Black or African American↗

PubMed1995

Effect of adenosine on the management of supraventricular tachycardia by urban paramedics.

STUDY OBJECTIVE: To determine the effect of the addition of adenosine, as a standing-order medication, on the prehospital management of supraventricular tachycardia (SVT) in a large urban emergency medical services (EMS) system. DESIGN: Prospective observational case series with historical controls. SETTING: Large urban municipal EMS system staffed by paramedics and emergency medical technicians trained to operate automatic or semiautomatic defibrillators (EMT-Ds). PARTICIPANTS: We observed a consecutive sample of prehospital patients who presented with an initial ECG rhythm of SVT, as interpreted by the treating paramedics, between July 1 and December 31, 1993. We used patients from the same 6-month period in 1992 as our control group. Indications for treatment were chest pain, evidence of myocardial ischemia, or shock. Adenosine had been introduced as a first-line medication to be used under standing orders in cases of unstable SVT before a physician was contacted for medical control options. RESULTS: We studied 239 cases and 228 controls. Acceptable call reports with pretreatment and posttreatment ECGs were available for 140 (59%) of the study cases and 104 (46%) of the controls. The two groups were similar in terms of age, sex, and initial vital signs. In the control group, 75 patients had indications for treatment, and 16 were treated (21%). In the study group, 127 had indications for treatment and 103 (81.1%) were treated (odds ratio, 15.83; 95% confidence interval, 7.38-34.4). CONCLUSION: The introduction of adenosine as a standing-order medication into an urban EMS system increased the proportion of patients who received advanced life support treatment. Paramedics were able to accurately diagnose and begin treatment of SVT with adenosine without direct medical supervision.

Adenosine↗

PubMed1994

Detecting climate-induced patterns using wavelet analysis.

One of the difficulties encountered in the detection of ecosystem responses to climate change is distinguishing climate-induced patterns from those created by other sources. For example, changes in the trend of stream discharge records over time may reflect a composite response of changes in the climate (i.e. precipitation and temperature), land-use (e.g. timber harvesting and grazing), and local basin characteristics. Methods which quantify and relate information of temporal and spatial patterns across scales are critical to assess climatically induced changes in the forest and stream ecosystems. A methodology utilizing wavelet analysis is introduced for the purpose of identifying and isolating inferred climatic components of the hydrologic record. Trends observed in stream discharge records from eastern Oregon, USA are identified and used to illustrate the utility of a new time series technique, wavelet analysis, as a complementary approach for discerning pattern. This methodology affords an informed procedure for choosing filter dimensions for the purpose of signal decomposition. The wavelet cross-covariance is applied to precipitation and discharge records to identify the climatic component in the discharge record. Reconstruction of these dominant frequencies is effected to isolate the climatic components. The discharge pattern shows two dominant scales of pattern coincident with the precipitation record. A 3-year half-period pattern is found to be correlated with the Southern Oscillation Index at the same frequency.

Journal Article↗

PubMed1982

Origin of the pH dependence of the midpoint reduction potential in Clostridium pasteurianum ferredoxin:oxidation state-dependent hydrogen ion association.

The origin of the dependence of E1/2 on pH exhibited by Clostridium pasteurianum 2(4Fe-4S) ferredoxin has been investigated. The results show that oxidation state-dependent pK values, which may arise from sites on the iron-sulfur centers, are responsible for the pH effect. Based on a model of two equivalent protonation sites/molecule, values of 7.4 for pKox and 8.9 for pKrd were obtained. The results of experiments which monitor changes in the hydrogen ion concentration with changes in protein oxidation state are reported. The magnitude of the changes in pH on reduction or reoxidation of the protein are in reasonable agreement with the proposed model. The conformation of C. pasteurianum ferredoxin was examined by nmr, epr, and CD spectroscopies to rule out a pH-dependent conformation equilibrium as the origin of the pH effect.

Clostridium↗

PubMed1979

Determination of cooperative interaction between clusters in Clostridium pasteurianum 2 (4Fe-4S) ferredoxin.

The effect of reducing one 4Fe-4S cluster in Clostridium pasteurianum 2 (4Fe-4S) ferredoxin on the reduction potential of the unreduced cluster has been investigated. While such an effect is suggested by both the x-ray structure of Peptococcus aerogenes 2 (4F-4S) ferredoxin and the polypeptide conformational change on reduction present in clostridial-type 2 (4Fe-4S) ferredoxins, present studies indicate that cluster-cluster cooperative interaction is not strong enough to be of functional importance in these proteins.

Clostridium↗

PubMedDate not supplied

The role of EMS systems in public health emergencies.

INTRODUCTION: Until now, the public health response to the threat of an epidemic has involved coordination of efforts between federal agencies, local health departments, and individual hospitals, with no defined role for prehospital emergency medical services (EMS) providers. METHODS: Representatives from the local health department, hospital consortium, and prehospital EMS providers developed an interim plan for dealing with an epidemic alert. The plan allowed for the prehospital use of appropriate isolation procedures, prophylaxis of personnel, and predesignation of receiving hospitals for patients suspected of having infection. Additionally, a dual notification system utilizing an EMS physician and a representative from the Office of Infectious Diseases from the hospital group was implemented to ensure that all potential cases were captured. Initially, the plan was employed only for those cases arising from the Centers for Disease Control and Prevention (CDC)/Public Health Service (PHS) quarantine unit at the airport, but its use later was expanded to include all potential cases within the 9-1-1 system. RESULTS: In the two test situations in which it was employed, the plan incorporating the prehospital EMS sector worked well and extended the "surveillance net" further into the community. During the Pneumonic Plague alert, EMS responded to the quarantine facilities at the airport five times and transported two patients to isolation facilities. Two additional patients were identified and transported to isolation facilities from calls within the 9-1-1 system. In all four isolated cases, Pneumonic Plague was ruled out. During the Ebola alert, no potential cases were identified. CONCLUSIONS: The incorporation of the prehospital sector into an already existing framework for public health emergencies (i.e., epidemics), enhances the reach of the public safety surveillance net and ensure that proper isolation is continued from identification of a possible case to arrive at a definitive treatment facility.

Disease Outbreaks↗