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Biomedical subjects

B Miller

Publications and source records attributed to B Miller.

At least 145 records · Page 8Linked to original sources

Throw that epidemiologist out of the emergency room! Using the television series ER as a vehicle for teaching methodologists about medical issues.

BACKGROUND: Epidemiology and biostatistics graduate students have diverse backgrounds, but many have little prior training in medicine or biology. This lack of content knowledge in future health researchers has recently been raised as a concern. METHODS: As part of a graduate course on the epidemiology of major diseases, the television series ER was used as a vehicle for learning more about diseases in general, and to become familiar with medical terminology and the ICD-10 by practicing coding on the patients seen. Furthermore, we wanted to provide human faces to the type of disease data students usually work with. RESULTS: In this article, the authors discuss how the ER sessions were organized and the problems that were encountered. The course evaluation concluded that the students found the exercise to be an interesting break from regular teaching.

Adult↗

Proliferating cells in the primary spongiosa express osteoblastic phenotype in vitro.

We have shown that intermittent parathyroid hormone (PTH) treatment targets proliferating cells in the primary spongiosa of trabecular bone of young rats, resulting in an increased number of osteoblasts. To further characterize these proliferating osteoprogenitor cells, bromodeoxyuridine (BrdUrd) incorporated in vivo, was used as a marker to identify and isolate cells for in vitro studies. Proliferating cells were labeled in vivo in young rats with BrdUrd and 24 h later were isolated by trypsinization of sections of the primary spongiosa of the distal femur metaphysis. Within 12 h of isolation, BrdUrd+ cells formed distinct foci containing 20-500 cells with fibroblast morphology. Stimulation of proliferation as determined by [3H]-thymidine incorporation was observed for these cells in response to fetal bovine serum, platelet derived growth factor, and transforming growth factor beta-1. Neither insulin-like growth factor-1 (IGF-1) nor insulin stimulated proliferation PTH (1-34) and dexamethasone inhibited proliferation. The effects of PTH and dexamethasone were additive. Cells expressed the osteoblast phenotype as evidenced by synthesis of type I collagen, expression of high alkaline phosphatase activity, and production of increased intracellular cAMP in response to PTH (1-34). Confluent cell aggregates spontaneously formed mineralized nodules within 4-7 days, in the absence of inducers. These observations suggest that the primary spongiosa cells recapitulates the differentiation process in vitro in an accelerated fashion and may serve as a useful model to study osteoblast differentiation.

Animals↗

Use of medical care by African American and White older persons: comparative analysis of three national data sets.

Historically, there has been a large gap between African Americans and Whites in access to health care, but this gap was ostensibly lessened by the advent of Medicare and Medicaid for older adults in the mid 1960s. The extent to which older African Americans continue to receive less access to medical care as a result of economic inequalities, institutionalized forms of discrimination, and life-style factors remains a subject of policy debate. Empirical enquiry has produced inconsistent results. The purpose of this study is to test the same set of models of medical use using identically measured predictor variables in three nationally representative data sets of older Americans: 1984 Study of Aging (SOA); 1984 National Long-Term Care Survey (NLTC); and the 1987 National Medical Care Expenditure Survey (NMES). Multivariate logistic regression of use of physician and hospital services and Poisson regression of amount of service use identified inconsistent results in race differences across data sets, but consistent results in terms of the importance of health status and insurance as predictors of use and amount of use. The findings suggest that health status and financial resources may be more relevant areas for policy interventions than considerations related to race and ethnicity.

Black or African American↗

A comparative analysis of ADL questions in surveys of older people.

This article describes questions designed to assess limitations with respect to activities of daily living (ADLs) that were asked on the first wave of the AHEAD study, and it assesses their cross-sectional measurement properties. It also provides comparisons between those questions and parallel questions that have been asked on two other surveys of the elderly population in the United States: the 1984 Supplement on Aging (SOA) to the National Health Interview Survey and the screener for the 1982 National Long Term Care Survey (NLTCS). It also compares a single item from the 1990 Census. It then compares the ways in which the same individuals answer these different versions of ADL questions, using data from subsamples of the AHEAD respondents who were also asked the SOA, NLTCS, or Census questions. The analysis shows that there is a substantial amount of measurement error in the answers to ADL questions, and it suggests that this is a major contributor to apparent improvements and declines in functional health observed in longitudinal data.

Activities of Daily Living↗

Assessment of preservation induced reperfusion injury via intraoperative renal transplant blood flow and endothelin concentration studies.

PURPOSE: We investigated a possible relationship between levels of the vasoconstrictive peptide endothelin and renal transplant reperfusion injury, and modified a technique for measuring renal blood flow with an ultrasonic perivascular transit time flow probe. MATERIALS AND METHODS: Renal grafts in a swine transplant model were cold flushed with either Collins-2 or University of Wisconsin solution. Renal blood flow and renal vein endothelin levels after reperfusion of transplanted grafts, as well as histological parameters within the transplanted kidney were measured. The 5-minute post-reperfusion renal blood flow was used as the baseline allograft flow. The definition of reperfusion injury was a decrease in flow from baseline with no recovery within 1 hour of reperfusion. In 9 human recipients reperfusion injury was further verified by monitoring subsequent serum creatinine, urine output, graft survival and rejection episodes. RESULTS: In the swine model and human transplant recipients no evidence of post-reperfusion ischemia was noted by histological examination, supporting that moderate to mild reperfusion injury or ischemic injury cannot be clinically determined with this method. In the swine model the decrease flow from baseline in allograft post-reperfusion renal blood flow was significantly greater in kidneys preserved in Collins'-2 than in University of Wisconsin solution (41.75 +/- 5.69 versus 11.18 +/- 13.99 ml. per minute, p = 0.005), supporting that this technique can assess mild to moderate reperfusion injury. The increase in serum endothelin in the allografts from the swine model and in humans was not significantly different from baseline. Clinically, post-reperfusion renal blood flow changes correlated well with subsequent function. The 4 patients with renal transplant reperfusion injury had significantly higher serum creatinine values and lower urine output 1 week postoperatively than 5 patients with no evidence of injury (serum creatinine: 6.75 +/- 3.03 versus 2.08 +/- 1.28 mg./dl., p = 0.015). Reperfusion injury patients had more rejections (2 versus 1) and less graft survival (75% versus 100%) at 1-year followup compared to the nonreperfusion injury patients. CONCLUSIONS: Vasoactive factors other than endothelin most likely contribute to reperfusion injury. Furthermore, the ultrasonic transit time flow probe accurately measures post-reperfusion renal blood flow and offers a practical method for assessing acute reperfusion injury, which may help to optimize immunosuppressive strategies to decrease allograft loss associated with delayed graft function.

Animals↗

Airway smooth muscle, tidal stretches, and dynamically determined contractile states.

In the classic theory of airway lumen narrowing in asthma, active force in airway smooth muscle is presumed to be in static mechanical equilibrium with the external load against which the muscle has shortened. This theory is useful because it identifies the static equilibrium length toward which activated airway smooth muscle would tend if given enough time. The corresponding state toward which myosin-actin interactions would tend is called the latch state. But are the concepts of a static mechanical equilibrium and the latch state applicable in the setting of tidal loading, as occurs during breathing? To address this question, we have studied isolated, maximally contracted bovine tracheal smooth muscle subjected to tidal stretches imposed at 0.33 Hz. We measured the active force (F) and stiffness (E), which reflect numbers of actin-myosin interactions, and hysteresivity (eta) which reflects the rate of turnover of those interactions. When the amplitude of imposed tidal stretch (epsilon) was very small, 0.25% of muscle optimal length, the steady-state value of F approximated the isometric force, E was large, and eta was small. When epsilon was increased beyond 1%, however, F and E promptly decreased and eta promptly increased. The muscle could be maintained in these steady, dynamically determined contractile states for as long as the tidal stretches were sustained; when epsilon subsequently decreased back to 0.25%, F, E, and eta returned slowly toward their previous values. The provocative stretch amplitude required to cause active force or muscle stiffness to fall by half, or hysteresivity to double, was slightly greater than 2%. These observations are consistent with a direct effect of stretch upon bridge dynamics in which, with increasing tidal stretch amplitude, the number of actin-myosin interactions decreases and their rate of turnover increases. We conclude that the interactions of myosin with actin are at every instant tending toward those that would prevail in the isometric steady state, but tidal changes of muscle length cause an excess in the rate of detachment. These stretch-induced detachment events can come so fast compared with the rate of attachment that static equilibrium conditions are never attained. If so, then airway lumenal narrowing and the underlying contractile state would be governed by a dynamic mechanical process rather than by a mechanical equilibrium of static forces.

Animals↗

The efficacy of calcium gluconate in ocular hydrofluoric acid burns.

1. Although calcium gluconate (CG) is recommended in the treatment of hydrofluoric acid (HF) eye burn its efficacy seems to be controversial, and controlled human or animal studies are limited. The study's objective is to compare the efficacy of 1% CG and normal saline irrigation for the treatment of HF eye injury in animals. 2. 0.05 ml 2% HF was instilled to anesthetized rabbit's eyes. One minute later, four treatment groups were studies: (1) irrigation with normal saline followed by topical antibiotics, corticosteroids and cycloplegics for 48 h (n = 10); (2) irrigation with 1% CG followed by the same topical treatment (n = 9); (3) as group 1 and 1% CG drops over 48 h (n = 10); (4) as group 3, and injection of 1% CG subconjunctivally after irrigation (n = 9). 3. Corneal erosion area, corneal haziness, conjunctival status, vascularization (pannus) and acidity were assessed before injury, immediately after initial treatment and 1, 2, 7 and 14 days thereafter by slit lamp aided by fluorescein staining. 4. Conjunctival pH dropped from 6.0-6.5 to 2.5-3 after injury and increased to 6-6.5 after irrigation. Corneal erosion: smaller in groups 2, 3, significantly so at 2 days, but not different at 14 days. Corneal haziness: more severe in group 4, at 14 days, insignificant. Conjunctival damage: significantly worse in group 4 at 2, 7 and 14 days. Pannus appeared in 2-4 eyes in each group. 5. It seems that for HF injury 1% CG did not have any significant advantage over saline irrigation and topical treatment only. It might have some initial and temporary effect on healing process especially that involving erosion. Given subconjunctivally, 1% CG may be toxic and worsens clinical outcome.

Administration, Topical↗

Assessment of CSF levels of tau protein in mildly demented patients with Alzheimer's disease.

CSF levels of tau protein are increased in many patients with Alzheimer's disease (AD). Studies disagree on whether the increase is found in moderate or severe AD to a greater extent than in mild AD, and in two reports there was an inverse correlation between tau levels and cognitive scores. To readdress this question, we measured CSF tau in a group of mildly impaired patients with AD (Mini-Mental State Examination [MMSE] scores > or =20/30) and compared their tau levels with those in age-comparable normal and neurologic controls. We found that the mean level of CSF tau was significantly increased in the AD group compared with the controls, and 29 of 36 patients with AD had levels that exceeded a cutoff determined in a previous study. CSF tau levels did not correlate with MMSE scores. These findings and those of previous studies show that elevated CSF tau levels are found in most patients with AD, occur early in the course of dementia, and may be useful in supporting the diagnosis of AD.

Aged↗

Evidence for association of HLA-A2 allele with onset age of Alzheimer's disease.

Our earlier studies had suggested a possible association between the HLA-A2 allele and Alzheimer's disease (AD). In the present study we tested the hypothesis that A2 is associated with earlier AD onset. We performed two independent studies: a collaborative study with 111 patients and a confirmatory study with 96 patients. We found similar patterns of reduced age at onset as a function of A2 in both data sets. Overall, A2 was associated with a significant 3-year shift to earlier onset. The effects of A2 and epsilon 4 on age at onset appeared additive. Our results suggest A2, or a closely linked gene, modulates onset age of AD. Association with A2 would suggest an immune/inflammatory response mechanism for AD.

Age of Onset↗

Seven days of erythromycin estolate is as effective as fourteen days for the treatment of Bordetella pertussis infections.

OBJECTIVE AND METHODS: Although 14 days of erythromycin is recommended for the treatment of Bordetella pertussis infection, there have been no prospective controlled studies to support the contention that this long course of therapy is required to eradicate the microorganism from the nasopharynx or to prevent bacteriological relapse. We randomly allocated children and adults with culture-positive community-acquired pertussis to either 7 or 14 days of erythromycin estolate treatment (40 mg/kg/d; maximum dose 1 g/d). Nasopharyngeal aspirate cultures were obtained by study nurses during home visits before and at the end of treatment, and 1 week after the completion of treatment. B pertussis-specific antibodies were measured before treatment and 1 month later. Information about clinical symptoms, adverse reactions, and compliance were collected at each scheduled contact. RESULTS AND CONCLUSIONS: A total of 168 participants were eligible for analysis (74 treated for 7 days and 94 treated for 14 days). Bacteriological persistence (positive end of therapy culture) occurred once in each group, and bacteriological relapse (positive culture 1 week after completion of treatment) occurred in one participant treated for 7 days. The overall failure rate (persistence plus relapse) of 2.70% in the 7-day group was not different than the rate of 1.06% in the 14-day group. The study had a power of 99.99% at the 5% level to detect a difference in failure rates of 10% and a power of 80% to detect a difference of 5%. We conclude that 7 days of erythromycin estolate is as effective as 14 days for the eradication of B pertussis.

Adolescent↗

Can physicians treat tuberculosis? Report on a national survey of physician practices.

OBJECTIVES: Researchers examined physicians' treatment strategies for tuberculosis to determine whether they would follow recommendations of the Centers for Disease Control and Prevention and the American Thoracic Society. METHODS: A national survey sampled 1772 physicians. Analyses tested correlates of recommended treatment regimens. RESULTS: Among respondents, 59.4% described a recommended regimen. Specialists; physicians aware of professional publications, treatment recommendations, and reporting requirements; and those having more than 50% of patients in nursing homes were more likely to describe recommended regimens. Physicians who had been in practice longer, relied on personal experience, or had more than 50% of patients receiving Medicaid were less likely to describe recommended regimens. CONCLUSIONS: Physicians who treat tuberculosis require training and support. Policymakers should consider who should treat tuberculosis and how recommended practice should be ensured.

Centers for Disease Control and Prevention, U.S.↗

Aligning organizational strategic planning and research priorities: the Kaiser experience.

Kaiser Permanente, the largest nonprofit HMO in the country, is a prepaid group practice program which provides comprehensive health benefits coverage to more than 8 million Americans in 17 states and the District of Columbia. The Northern California region of Kaiser Permanente is the largest region with more than 2.6 million members. This article describes the creation of a research effort in the Northern California region to develop a long-range strategic research plan. This effort was initiated in order to align research priorities with organizational strategic planning. The plan's aim was to better guide the process of using research to help the region meet its mission, goals and objectives. Twenty-seven strategic research areas were identified organized into four major categories. The top six strategic research areas are discussed.

California↗

Meeting JCAHO patient-education standards.

Specific standards and interdisciplinary coordination improve educational services and help to meet the Joint Commission on Accreditation of Healthcare Organization's standards. A flow chart detailing the patient/family education process is provided.

Family↗

The application of the macular photocoagulation study eligibility criteria for laser treatment in age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To analyze the application of the Macular Photocoagulation Study eligibility criteria for laser photocoagulation of choroidal neovascularization, in view of the expansion of these criteria in recent years. PATIENTS AND METHODS: The authors prospectively analyzed 50 eyes of 47 consecutive patients with exudative age-related macular degeneration (AMD) to determine their suitability for treatment. RESULTS: Fifteen eyes (30%) were found to be suitable for laser photocoagulation. Patients eligible for treatment were more likely to have experienced visual symptoms for a months or less (P = .006), to have a visual acuity of 20/200 or better (P = .009), and to be younger in age (P = .02). Visual symptoms experienced for a month or less were more prevalent in extrafoveal exudative lesions compared with the subfoveal type (P = .01) CONCLUSIONS: Despite recent advances, laser photocoagulation still can be applied only to a minority of the patients with neovascular AMD. Prompt ocular examination following the onset of visual symptoms is essential.

Aged↗