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Biomedical subjects

B Miller

Publications and source records attributed to B Miller.

At least 19 recordsLinked to original sources
PubMed2006

Factors influencing discharge location following high lesion spinal cord injury rehabilitation in British Columbia, Canada.

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To identify and describe factors that influence discharge location -- extended care unit (nursing home) or other (private home, group home, or acute care) -- following rehabilitation for individuals with a new high lesion spinal cord injury (SCI) (C1-C4) in British Columbia, Canada. SETTING: GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada. METHODS: Eligible clients were adults admitted to the GF Strong Rehabilitation Centre Spinal Cord Program between 1994 and 2003, with a new C1-4 lesion (traumatic or nontraumatic), and an ASIA score of A-C at time of discharge. Medical charts of 52 individuals were reviewed and data regarding individual characteristics, health-related characteristics, personal context, hospitalization factors, health resources, and other contextual factors were extracted. RESULTS: In total, 40% of clients were discharged to extended care units post rehabilitation. Seven variables were associated at a univariate level: age, employment at the time of injury, pre-existing medical conditions, social support, preinjury living situation, and insurance (worker's compensation or motor vehicle) or private funding for equipment. Four variables were associated at the multivariate level: age, preinjury living situation, and insurance or private funding for equipment. CONCLUSION: A range of individual, health-related, family and social policy variables influence discharge location following rehabilitation for high lesion SCI in British Columbia. The unique combination of variables presented by each individual should be considered by the rehabilitation team in the discharge planning process.

Adult↗
PubMed2006

Tuberculosis case finding and preventive therapy in an HIV voluntary counseling and testing center in Uganda.

SETTING: A large, urban human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) center in Kampala, Uganda. OBJECTIVE: Tuberculosis (TB) is a leading cause of morbidity and mortality in persons with HIV infection in sub-Saharan Africa. Intensified TB case finding and use of isoniazid preventive therapy (IPT) for latent infection reduces the burden of TB, but few programs have been implemented due to concerns about feasibility. DESIGN: Retrospective evaluation of a TB case finding and IPT program. RESULTS: Over a 25-month period, 6305 patients newly diagnosed with HIV infection underwent evaluation: 293 (5%) had TB disease; 1955 (37%) patients were not eligible for preventive therapy because they lived > 20 km away, had advanced HIV disease, or had previously had TB. Of 3366 who had a tuberculin skin test (TST) placed, 2548 (76%) had the TST read; 894 (35%) of these were positive. Of 506 persons who started treatment, 335 (66%) completed it. CONCLUSION: This unique program was feasible, detected a high proportion of undiagnosed TB, and successfully treated persons with latent infection. Expanding access to HIV VCT as well as collaboration between HIV/ AIDS and TB programs can increase the proportion of HIV-infected persons who can benefit from these programs.

Adolescent↗
PubMed2005

The influence of environment on development of the mucosal immune system.

The mucosal immune system expresses active responses against pathogens and also tolerance against harmless food and commensal bacterial antigens. The mechanisms that determine which of these outcomes occur after recognition of antigens by T-cells are not clear. One possibility is that it is determined by the initial interaction between a dendritic and a naïve T-cell in organised lymphoid tissue. However, such organised structures are, evolutionarily, quite recent and the original immune system must have made appropriate responses in more diffuse immunological architecture; a second possibility is that the critical interaction is between primed T-cells and their environment, in the lamina propria of the intestine. The mucosal immune system of neonates is poorly developed and inefficient at expressing appropriate immune responses. Development is influenced by a range of environmental factors including maternally derived antigen or antibody and commensal flora and pathogens. The intestine is a complex immunological structure in which the immune system and the macro- and microenvironment interact.

Animals↗
PubMed2005

[Amiodarone-induced thyrotoxicosis: a diagnostic and therapeutic challenge].

Amiodaron is a widely used antiarrhytmic drug in a number of cardiac conditions. The most common side effects affect the thyroid gland (14-18% of treated patients) resulting in hypothyroidism or hyperthyroidism. We describe a complex case of amiodaron-induced thyrotoxicosis (AIT) and discuss the pathogenesis of the different subtypes (AIT I, II and mixed forms) and the diagnostic and therapeutic challenges in such patients.

Amiodarone↗
PubMed2005

Ambulatory-care diagnoses as potential indicators of outbreaks of gastrointestinal illness--Minnesota.

INTRODUCTION: Syndromic surveillance's capability to augment existing surveillance for community-acquired gastrointestinal disease is unknown. OBJECTIVE: The objective of this study was to evaluate the capability of a syndromic surveillance system to detect outbreaks of gastrointestinal disease. METHODS: A retrospective analysis was conducted comparing ambulatory care data from a health plan with a set of 110 gastrointestinal-disease outbreaks identified by the Minnesota Department of Health during 2001-02. Unusual clusters of illness (i.e., signals) in the health-plan data were identified by analyzing daily counts of gastrointestinal illness using an adjusted space-time scan statistic. Concordance was defined as < or =5 km between outbreak and signal and the signal occurring within 1 week of the outbreak. RESULTS: During 104 weeks, the number of signals was roughly what would have been expected by chance, suggesting that the modeling did a good job of estimating the expected counts of illness and that false alarms would not have occurred much more often than the number predicted at the various thresholds. During the same period, the health department identified 110 eligible gastrointestinal outbreaks. Apparent associations of the three statistically most unusual concordant signals with outbreaks of viral or bacterial gastrointestinal illness were ruled out by the health department on the basis of detailed knowledge of the circumstances and low numbers of affected persons seeking medical care. CONCLUSION: No previously known gastrointestinal outbreaks were identified by this surveillance system. However, relatively few recognized outbreaks resulted in patients seeking medical care, and the sensitivity of this system to detect outbreaks of real significance to public health remains to be determined. Prospective evaluation probably will be required to understand the usefulness of syndromic surveillance systems to enhance existing disease surveillance.

Ambulatory Care↗
PubMed2005

Collagen synthesis in human musculoskeletal tissues and skin.

We have developed a direct method for the measurement of human musculoskeletal collagen synthesis on the basis of the incorporation of stable isotope-labeled proline or leucine into protein and have used it to measure the rate of synthesis of collagen in tendon, ligament, muscle, and skin. In postabsorptive, healthy young men (28 +/- 6 yr) synthetic rates for tendon, ligament, muscle, and skin collagen were 0.046 +/- 0.005, 0.040 +/- 0.006, 0.016 +/- 0.002, and 0.037 +/- 0.003%/h, respectively (means +/- SD). In postabsorptive, healthy elderly men (70 +/- 6 yr) the rate of skeletal muscle collagen synthesis is greater than in the young (0.023 +/- 0.002%/h, P < 0.05 vs. young). The rates of synthesis of tendon and ligament collagen are similar to those of mixed skeletal muscle protein in the postabsorptive state, whereas the rate for muscle collagen synthesis is much lower in both young and elderly men. After nutrient provision, collagen synthesis was unaltered in tendon and skeletal muscle, remaining at postabsorptive values (young: tendon, 0.045 +/- 0.008%/h; muscle, 0.016 +/- 0.003%/h; elderly: muscle, 0.024 +/- 0.003%/h). These results demonstrate that the rate of human musculoskeletal tissue collagen synthesis can be directly and robustly measured using stable isotope methodology.

Adult↗
PubMed2005

Dissociative photoionization and thermochemistry of dihalomethane compounds studied by threshold photoelectron photoion coincidence spectroscopy.

The dissociative photoionization studies have been performed for a set of dihalomethane CH(2)XY (X,Y = Cl, Br, and I) molecules employing the threshold photoelectron photoion coincidence (TPEPICO) technique. Accurate dissociation onsets for the first and second dissociation limits have been recorded in the 10-13 eV energy range, and ionization potentials have been measured for these compounds. By using our experimental dissociation onsets and the known heat of formation of CH(2)Cl(2) molecule, it has been possible to derive the 0 and 298 K heats of formation of all six neutral dihalomethanes as well as their ionic fragments, CH(2)Cl(+), CH(2)Br(+), and CH(2)I(+), to a precision better than 3 kJ/mol. These new measurements serve to fill the lack of reliable experimental thermochemical information on these molecules, correct the old literature values by up to 19 kJ/mol, and reduce their uncertainties. From our thermochemical results it has also been possible to derive a consistent set of bond dissociation energies for the dihalomethanes.

Journal Article↗
PubMed2005

The development of the mucosal immune system pre- and post-weaning: balancing regulatory and effector function.

The mucosal immune system fulfils the primary function of defence against potential pathogens that may enter across vulnerable surface epithelia. However, a secondary function of the intestinal immune system is to discriminate between pathogen-associated and 'harmless' antigens, expressing active responses against the former and tolerance to the latter. Control of immune responses appears to be an active process, involving local generation of IgA and of regulatory and/or regulated T lymphocytes. Two important periods of maximum exposure to novel antigens occur in the young animal, immediately after birth and at weaning. In both cases the antigenic composition of the intestinal contents can shift suddenly, as a result of a novel diet and of colonisation by novel strains and species of bacteria. Changes in lifestyles of man, and husbandry of animals, have resulted in weaning becoming much more abrupt than previously in evolution, increasing the number of antigens that must be simultaneously evaluated by neonates. Thus, birth and weaning are likely to represent hazard and critical control points in the development of appropriate responses to pathogens and harmless dietary and commensal antigens. Neonates are born with relatively undeveloped mucosal immune systems. At birth this factor may prevent both expression of active immune responses and development of tolerance. However, colonisation by intestinal flora expands the mucosal immune system in antigen-specific and non-specific ways. At weaning antibody to fed proteins can be detected, indicating active immune responses to fed proteins. It is proposed that under normal conditions the ability of the mucosal immune system to mount active responses to foreign antigens develops simultaneously with the ability to control and regulate such responses. Problems arise when one or other arm of the immune system develops inappropriately, resulting in inappropriate effector responses to harmless food proteins (allergy) or inadequate responses to pathogens (disease susceptibility).

Animals↗
PubMed2005

Effect of a very late antigen-4 receptor antagonist on allergen-induced airway responses and inflammation in asthma.

BACKGROUND: Very late antigen-4 (VLA(4)) plays a key role in the recruitment of eosinophils in allergic responses in animal studies. OBJECTIVE: We investigated whether pretreatment with multiple doses of a VLA(4) receptor antagonist, HMR 1031, protects against allergen-induced airway responses and airway inflammation in humans. METHODS: Fourteen asthmatics (7F/7M), 18-49 years, PC(20) forced expiratory volume in 1 s (FEV(1)) methacholine (M) (<8 mg/mL; FEV(1) 82.3-116.1% predicted) with dual responses to inhaled allergen participated in a double-blind, placebo-controlled, cross-over study. Each treatment period consisted of 9 days, separated by >or=2 weeks. Exhaled nitric oxide (eNO), PC(20)FEV(1)(M) and hypertonic saline-induced sputum was obtained on Days 1, 7 and 9. Subjects inhaled HMR 1031 (20 mg b.i.d.) or placebo (P) on Days 1--8. On Day 8, an allergen bronchoprovocation test was performed, the airway response was measured by FEV(1), and expressed as %fall from baseline. Data from 12 evaluable subjects are presented here. RESULTS: Both treatments were well tolerated. There was no significant difference between HMR 1031 and P in the early asthamatic response: mean AUC (0-3 h)+/-SEM (%fall h): 26.01+/-4.26 and 17.41+/-4.26, respectively (P=0.18), nor in the late response: mean AUC (3-9 h)+/-SEM (%fall h): 97.09+/-8.63 and 97.61+/-8.63, respectively, P=0.97. This corresponded to the absence of significant allergen-induced changes in PC(20)FEV(1)(M), eNO, sputum eosinophils and soluble inflammation markers between both treatment periods. CONCLUSIONS: Treatment with multiple inhaled doses of the VLA(4) antagonist, HMR 1031, did not result in detectable protection against allergen-induced airway responses or airway inflammation in asthma.

Administration, Inhalation↗
PubMed2005

A proposed model for a collaborative approach to dental hygiene research.

As dental hygiene responds to the increased need for quality oral health services, dental hygienists seek quality research findings on which to base their practice decisions. However, the amount of research published by dental hygienists, and addressing dental hygiene interventions, remains limited. There are few dental hygienists in Canada working in positions that have time dedicated to research activities. To increase the amount of dental hygiene research, innovative approaches such as collaborative research must be considered. This paper considers measures that facilitate the conduct of collaborative research, and discusses challenges to the process that should be considered during the design. An example of a group investigation is presented, involving dental hygiene educators who collaborated on a research project implemented within their respective educational institutions. A model for a collaborative approach to future research initiatives is proposed. Lessons learned are shared and recommendations are put forward. It is suggested that innovative collaborations such as this may help to increase the body of knowledge for dental hygiene in Canada.

Canada↗
PubMed2004

Deformation tensor morphometry of semantic dementia with quantitative validation.

High-resolution structural MRI scans of 20 subjects diagnosed with semantic dementia were compared against scans of 20 cognitively normal control subjects using whole brain deformation tensor morphometry to study spatially consistent differences in local anatomical size. A fine lattice free-form volume registration algorithm was used to estimate a continuous mapping from a reference MRI to each individual subject MRI. The Jacobian of these transformations at each voxel were used to quantitatively map relative anatomical size in each individual brain. Intensity consistent filtering was applied to the determinant of these Jacobians. A careful validation using manually traced gyral anatomy was carried out and used to select an optimal deformation tensor filter scale at which to examine the anatomical size maps. General linear modeling at each voxel was used to decompose the influence of age and head size from the primary diagnosis. Maps of the T statistic of the diagnosis across the 40 subjects highlighted significant (P < 0.01 Bonferroni corrected) focal tissue contraction effects related to dementia diagnosis in the left temporal pole extending into the hippocampus, occipitotemporal gyrus and parahippocampal gyrus. Some evidence of greater focal contraction in gray over white matter was also apparent. Contraction effects were also seen, but with reduced significance in the right temporal anatomy, focused toward the temporal pole and hippocampal regions. Additional lower significance findings (P < 0.05 permutation corrected) were detected in the left superior frontal gyrus, left orbital gyrus and left parietal lobe.

Aged↗
PubMed2004

Multivisceral transplantation for pediatric intestinal pseudo-obstruction: single center's experience of 16 cases.

Chronic intestinal pseudo-obstruction (CIPO) in children may be life-threatening due to the complications of parenteral nutrition (PN) or catheter-related sepsis. Multivisceral transplantation (MVTx) is a lifesaving option but limited experience is available. We report our experience with MVTx in pediatric CIPO patients. Sixteen children with CIPO underwent MVTx at median age of 4 years. Indications for MVTx were liver failure (n = 10), loss of venous access (n = 3), or sepsis (n = 3). Modified MVTx without the liver was performed in six patients. Induction immunosuppression included tacrolimus, steroid with adjunctive agent in period I (April 1996 to December 2000), namely, OKT3 (n = 1), mycophenolate mofetil (n = 4), or daclizumab (n = 2); and in period II (January 2001 to present), Campath 1H (n = 4) or daclizumab (n = 5). The grade of rejection was severe in 12.5% and mild to moderate in 87.5% of cases. Isolated rejection of the transplanted stomach or pancreas was not diagnosed during clinical course or on autopsy. Actuarial patient survival for 1 year/2 years for period, I and II were 57.1%/42.9% and 88.9%/77.8%. None of the long-term survivors is on PN and all tolerate enteral feedings. Pancreatic enzyme supplementation or insulin therapy is not needed in survivors. Gastric emptying was substantially affected in one case. Bladder function did not improve in those with urinary retention problems. MVTx for CIPO offers a lifesaving option with excellent function of the transplanted pancreas and stomach among survivors.

Child↗
PubMed2003

Boundary conditions at the tendon-bone interface.

The reconstruction of a tendon-bone interface, as in rotator-cuff repairs, remains a challenging surgical problem. There is however, little data to show what effect joint position or repair loading under physiological conditions have on the repaired tendon-bone interface. A change in the amount of contact area or load at the tendon-bone interface may influence healing. In this study we investigated the effect of limb position and boundary conditions on the tendon-bone interface in an in vitro rabbit tendon-bone repair model using both unlinked and linked suture repairs.

Animals↗