Olaf Mickelsen (July 29, l912 to August 8, 1999).
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Animals↗
Biomedical subjects
B Bowman
Publications and source records attributed to B Bowman.
Recommending calcium to reduce lead toxicity in children: a critical review.
Assertions that adequate or supplemental calcium intake can reduce lead absorption in children are based on liberal extrapolation from animal studies, experiments with human adults, and cross-sectional studies of children that have a variety of methodologic weaknesses. Without stronger supporting evidence, statements that diet can ameliorate the deleterious effects of environmental lead could provide a false sense of efficacy and divert efforts from lead abatement and from behavioral modifications that might have more impact.
Absorption↗
Nutrient intakes and dietary patterns of young children by dietary fat intakes.
OBJECTIVE: To determine whether low fat intake is associated with increased risk of nutritional inadequacy in children 2 to 8 years old and to identify eating patterns associated with differences in fat intake. STUDY DESIGN: Using 2 days of recall from the Continuing Survey of Food Intake by Individuals (CSFII), 1994 to 1996, we classified 2802 children into quartiles of energy intake from fat (<29%, 29% to 31.9% [defined as moderate fat], 32% to 34.9%, and > or =35%) and compared nutrient intakes, the proportion of children at risk for inadequate intakes, Food Pyramid servings, and fat content per serving across quartiles. RESULTS: More children in quartile 2 were at risk for inadequate intakes of vitamin E, calcium, and zinc than children in higher quartiles (P <.0001); more children in quartiles 3 and 4 were at risk for inadequate intakes of vitamins A and C and folate (P <.001). Fruit intake decreased across quartiles (P <.0001); whereas vegetable, meat, and fat-based condiment intakes increased (P <.0001). Fat per serving of grain, vegetables, dairy, and meat increased across quartiles (P <.0001). CONCLUSIONS: Moderate-fat diets were not consistently associated with an increased proportion of children at risk for nutritional inadequacy, and higher-fat diets were not consistently protective against inadequacy. Dietary fat could be reduced by judicious selection of lower-fat foods without compromising nutritional adequacy.
Child↗
Trends in fruit and vegetable consumption among adults in 16 US states: Behavioral Risk Factor Surveillance System, 1990-1996.
OBJECTIVES: This study examined trends in fruit and vegetable consumption among adults in 16 US states. METHODS: Data from telephone surveys were used to stratify respondents by sociodemographic and health-related characteristics. RESULTS: The proportion of adults who consumed fruits and vegetables at least 5 times daily was 19%, 22%, and 23% in 1990, 1994, and 1996, respectively. While the proportion increased among those with active leisure-time physical activities and normal weight, it remained almost the same among inactive people and dropped among the obese. CONCLUSIONS: Progress in fruit and vegetable intake from 1990 to 1994 was encouraging, but it changed little between 1994 and 1996.
Adolescent↗
Negative pressure ventilation via chest cuirass to decrease ventilator-associated complications in infants with acute respiratory failure: a case series.
Pulmonary and nonpulmonary complications of invasive positive pressure ventilation are well documented in the medical literature. Many of these complications may be minimized by the use of noninvasive ventilation. During various periods of medical history, negative pressure ventilation, a form of noninvasive ventilation, has been used successfully. We report the use of negative pressure ventilation with a chest cuirass to avoid or decrease the complications of invasive positive pressure ventilation in three critically ill infants at two institutions. In each of these cases, chest cuirass ventilation improved the patient's clinical condition and decreased the requirement for more invasive therapy. These cases illustrate the need for further clinical evaluation of the use of negative pressure ventilation utilizing a chest cuirass.
Acute Disease↗
Predictors of injury among adult recreational in-line skaters: a multicity study.
OBJECTIVES: This study examined risk factors for injury, injury prevalence, safety gear use, and skating habits of adult recreational in-line skaters. METHODS: Randomly selected in-line skaters in 6 major US cities were interviewed. RESULTS: Only 6% of skaters consistently wore all 4 recommended types of safety gear. Skaters with greater skating experience were more likely to perform tricks, wear less safety gear, and sustain an injury. CONCLUSION: More experienced adult recreational in-line skaters are at increased risk for injury. Safety gear use in alarmingly low in adult recreational in-line skaters, especially experienced skaters. Safe skating education programs should consider targeting this newly recognized at-risk skating population.
Adult↗
Characterization of HIV type 1 gp120 V3 region sequences from Ugandan infants.
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Amino Acid Sequence↗
In vitro verification of myocardial motion tracking from phase-contrast velocity data.
The ability to track motion from cine phase-contrast (PC) magnetic resonance (MR) velocity measurements was investigated using an in vitro model. A computer-controlled deformable phantom was used for the characterization of the accuracy and precision of the forward-backward and the compensated Fourier integration techniques. Trajectory accuracy is limited by temporal resolution when the forward-backward technique is used. With this technique the extent of the calculated trajectories is underestimated by an amount related to the motion period and the sequence repetition time, because of the band-limiting caused in the cine interpolation step. When the compensated Fourier integration technique is used, trajectory accuracy is independent of temporal resolution and is better than 1 mm for excursions of less than 15 mm, which are comparable to those observed in the myocardium. Measurement precision is dominated by the artifact level in the phase-contrast images. If no artifacts are present precision is limited by the inherent signal-to-noise ratio of the images. In the presence of artifacts, similar in magnitude to those observed in vivo, the reproducibility of tracking a 2.2 x 2.2 mm2 region of interest is better than 0.5 mm. When the Fourier integration technique is used, the improved accuracy is accompanied by a reduction in precision. We verified that tracking three-dimensional (3D) motion from velocity measurements of a single slice can lead to underestimations of the trajectory if there is a through-plane component of the motion that is not truly represented by the measured velocities. This underestimation can be overcome if volumetric cine phase-contrast velocity data are acquired and full three-dimensional analysis is performed.
Artifacts↗
Controlled delivery of vascular endothelial growth factor promotes neovascularization and maintains limb function in a rabbit model of ischemia.
PURPOSE: Vascular endothelial growth factor (VEGF) modulates new blood vessel development and growth and has been suggested as a potential therapeutic agent that could alleviate debilitating claudication in patients. The objective of this study was to determine whether controlled, local delivery of a low dose of VEGF from an osmotic pump could promote neovascularization, limb perfusion, and functional improvements in the hind limbs of rabbits rendered partially ischemic by surgery. The effects of VEGF were compared with those of the vasodilator nitroglycerin (NTG) and to saline administered similarly. METHODS: Thirty rabbits were randomly assigned to either VEGF (n = 10), NTG (n = 10), or saline (n = 10) treatment groups. Partial ischemia was induced in each left hind limb by surgical ligation of the common and superficial femoral arteries, leaving the internal iliac artery intact. The right limb of each animal served as a nonischemic control. Immediately after vessel ligations, a 28-day osmotic pump was implanted to deliver VEGF (0.22 microg/kg/day), NTG (17.8 microg/kg/day), or saline solution into the common iliac artery just proximal to the ligation site. Comparative vascularity between ischemic and nonischemic limbs within treatment groups and between groups was evaluated by (1) capillary counts from representative fields of hematoxylin and eosin stained muscle tissue taken from hind limbs at day 40; (2) digitized arteriograms of ischemic legs at day 40, which were used to quantify the complexity of vascular branching (fractal dimension index) and the total extent of vascularization (vascular density index); (3) measuring capillary refill times in ischemic limbs; and (4) observations of functional and trophic changes in ischemic limbs. Statistical differences between treatment groups were evaluated by one-way ANOVA. RESULTS: Complexity of vascular branching and vascular density were significantly greater (p < 0.001) in VEGF-treated ischemic limbs compared with NTG- and saline-treated ischemic limbs. By postoperation day 14, all VEGF-treated ischemic limbs had restored capillary refill (p < 0.001), new hair growth, and greatly improved limb function and appearance. Saline-treated limbs exhibited ischemic changes, with poor capillary refill and negligible limb function. Capillary refill in NTG-treated ischemic limbs did not differ significantly from saline-treated limbs. Ischemic VEGF-treated limbs had significantly more capillaries compared with both ischemic and nonischemic limbs in saline-treated animals (p < 0.05). Ischemic NTG-treated limbs also had significantly more capillaries compared with ischemic limbs in saline-treated animals (p < 0.05). Because of high variability, however, capillary counts in VEGF-treated ischemic limbs did not differ significantly from those of contralateral nonischemic limbs, or from capillary counts in either ischemic or nonischemic limbs of NTG-treated rabbits. CONCLUSIONS: Controlled release of microgram quantities of VEGF significantly enhanced neovascularization and vascular perfusion in ischemic limbs compared with controls in this rabbit model of partial ischemia. In addition, VEGF-treated ischemic limbs demonstrated near-normal function and appearance, whereas NTG- and saline-treated ischemic controls remained noticeably impaired. This novel approach of VEGF delivery may prove clinically useful either alone or combined with revascularization procedures.
Analysis of Variance↗
Molecular phylogeny and taxonomy of medically important fungi.
Some recent advances in study of molecular evolution and taxonomy of human pathogens are discussed. In systemic Onygenales as well as in Chaetothyriales, pathogenic species are phylogenetically intermingled with non-pathogenic taxa. When a teleomorph of Coccidioides immitis is eventually found, it is predicted to resemble Uncinocarpus, a genus otherwise comprising environmental species. In the dermatophytes, Trichophyton and Microsporum are paraphyletic, whereas Epidermophyton is polyphyletic. On the basis of 18S and ITS rDNA sequencing data, Exophiala anamorphs (black yeasts) are confirmed to be closely related to the ascomycete genus Capronia. The related neurotropic species Cladophialophora bantiana is remarkable in consistently having introns in its 18S rDNA gene.
Animals↗
Granulocyte colony-stimulating factor upregulates the vacuolar proton ATPase in human neutrophils.
We have previously shown that granulocyte colony-stimulating factor (G-CSF ) delays spontaneous neutrophil apoptosis through activation of the vacuolar proton ATPase (v-ATPase). We have now examined the regulation of the v-ATPase in neutrophils exposed to G-CSF in vitro. When neutrophils were cultivated in the absence of G-CSF, the 57-kD cytosolic B subunit of the v-ATPase disappeared within 1 to 2 hours, its loss preceding the nuclear changes of apoptosis and coinciding with the onset of acidification. By contrast, in neutrophils cultured for 2 hours in the presence of G-CSF, the amount of the 57-kD subunit was similar to that in freshly isolated neutrophils. However, inhibition of protein synthesis with cycloheximide and actinomycin D led to loss of the 57-kD subunit even in the presence of G-CSF. These results indicated that ongoing protein synthesis was required to maintain the v-ATPase, and further suggested that G-CSF acted, at least in part, by maintaining synthesis of the 57-kD cytosolic subunit. G-CSF also promoted the translocation of the 57-and 33-kD cytosolic v-ATPase subunits to the membrane. Our findings suggested two coordinate mechanisms by which the activity of the v-ATPase could be increased by G-CSF: the synthesis of cytosolic v-ATPase subunits and their translocation to the membrane.
Adult↗
Serum ferritin iron, a new test, measures human body iron stores unconfounded by inflammation.
Serum ferritin protein is an acute phase reactant. We hypothesized that serum ferritin protein generated in response to an inflammatory process would have much less iron (Fe) in it than would "normal" ferritin protein, and therefore measuring serum ferritin iron would assess human body iron status unconfounded by inflammation. BASIC METHODS: We measured serum ferritin iron in 140 clinical samples obtained from the serum banks of Bronx VA Medical Center Hematology and Nutrition Laboratory (Bronx, NY), the CDC Nutritional Biochemistry serum sample bank (Atlanta, GA), and the sample bank from patients with thalassemia and iron overload treated at New York Hospital (New York, NY). Each was analyzed for three conventional criteria of iron status: serum iron, percentage of transferrin saturation and ferritin protein. In addition, tests for inflammation were also performed: C-reactive protein, WBC and transaminases. Seventy-seven patients' sera from 140 screened met each of three consistent criteria for stages of iron status. Serum ferritin was immobilized by immunoprecipitation with rabbit antihuman polyclonal antibody bound to agarose and separated from other iron-containing proteins, digested with 0.2 ml of 3N nitric acid and analyzed for iron content by atomic absorption spectroscopy. RESULTS: Serum ferritin iron ranged in normal controls from 10 ng to 35 ng Fe/ml. The patients with iron deficiency (4/4) and those in negative iron balance (5/6) had values < or = 10 ng. Positive iron balance (8/9) and iron overload (22/22) values were > 35 ng/ml, in contrast to 11/19 with inflammation. Seventeen of twenty-two with overload had values > 100 ng/ml while only 1/19 with inflammation had such a value. Ferritin iron in ferritin protein was > 15% by weight in 14/22 with iron overload but in 0/19 with inflammation. IMPLICATIONS OF THE WORK: Serum ferritin iron is a simple, direct measure of iron stores that we propose, in conjunction with measuring serum ferritin protein, as a minimally invasive screening procedure for accurately assessing the whole range of human body iron status, unconfounded by inflammation.
Blood Chemical Analysis↗
A summary of the associate and baccalaureate degree curriculum models for health information management, Part I.
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Curriculum↗
Curriculum model for baccalaureate degrees programs in HIM, Part II: Focus on educational outcomes and curriculum content.
This the second in a series of three articles discussing curriculum models for associate and baccalaureate degree programs in health information management (HIM). Part I discussed the development of the models and presented a composite summary of selected key sections within the models. Part II focuses on the educational outcomes, curriculum content, and clinical experience expectations for the baccalaureate degree curriculum model. Part III will do the same for the associate degree curriculum model.
Competency-Based Education↗
Curriculum model for associate degree programs in HIM, Part III: Focus on educational outcomes and curricular content.
This is the last in a series of three articles that discuss curriculum models for associate and baccalaureate degree programs in health information management (HIM). Part I discussed the development of the models and presented a composite summary of key sections within the models. Part II focused on the baccalaureate degree curriculum model sections, which addressed educational outcomes, curricular content, and clinical experience expectations. Part III addresses these same sections, but in regard to the associate degree curriculum model.
Curriculum↗
Migraine-related visual-field loss with prolonged recovery.
BACKGROUND: Migraine is a complex neurologic syndrome that commonly causes visual disturbances. Although migraine visual disturbances are usually transient in nature, persistent or permanent visual field defects may occur. When persistent visual-field loss is found-even if migraine is suspected-appropriate workup must be performed to rule out other causes of vision loss. CASE REPORTS: Two patients went to the eye clinic for comprehensive examination. One patient with symptomatic visual loss and one patient with asymptomatic visual loss were evaluated by serial ophthalmic examinations, neurologic/medical evaluations, computed tomography of the head, and laboratory results. Each patient reported a history consistent with migraine, and each demonstrated resolution of persistent visual-field defects that had been present longer than 10 days. Since ophthalmic, medical, laboratory, and imaging results did not identify and etiology other than migraine as the cause of the vision loss, it is likely that each case represents a specific form of complicated migraine. CONCLUSIONS: Previous reports suggest that migraine-related visual deficits usually become permanent if persistent for more than 7 days. These reports demonstrate that visual recovery may still occur when field defects are present for 10 days or more.
Adult↗
The ABCs of physician billing compliance plans.
As it evolves, an organization's compliance plan will become an effective risk-management tool. As the price for noncompliance becomes ever higher, the development and implementation of a corporate compliance plan makes both common and fiscal sense. A compliance plan should not be a program that is rolled out and then allowed to sit on the shelf and gather dust. The only thing worse than not having a compliance plan is having one and not following it.
Fraud↗
Pediatric emergency medicine fellow clinical work requirements.
A wide range of clinical requirements exists among PEM fellowship programs. Programs are equally split concerning the question of whether fellows should work with supervision or independently in the first year; a significant number of fellowship programs require continued supervision of fellows in subsequent years. Orientation for first year fellows and requirements for completion of PALS, advanced pediatric life support (APLS), ACLS, or ATLS courses prior to their first independent shift varied greatly. In particular, a minority of programs required ATLS completion even though a majority of overall fellowship programs operate in a hospital designated as a Level 1 Trauma Center. Programs in which first-year fellows worked independently had fewer attendings and were less likely to provide 24-hour coverage. Fellows appear to work a similar or less demanding schedule than PEM attendings in most fellowship programs, and most fellowship directors feel that their fellows should continue with their current schedule.
Education, Medical, Graduate↗