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Biomedical subjects

C Brown

Publications and source records attributed to C Brown.

At least 577 records · Page 32Linked to original sources
PubMedDate not supplied

Visceral slide for intraperitoneal adhesions? A prospective study in 48 patients with surgical correlation.

Bowel perforation in patients undergoing laparoscopic surgery is an uncommon but serious complication. Bowel adherent to the anterior abdominal wall due to adhesions is considered a particular risk. It has been suggested that transabdominal ultrasound can reliably predict the presence of intraperitoneal adhesions. Normal bowel excursions (visceral slide) in 15 volunteers with no history of surgery or peritonitis and in 48 patients undergoing abdominal surgery were evaluated. Visceral slide during spontaneous respiration (SRSL) with manual compression (MCSL) and exaggerated respiration (ESL) was assessed in all 4 quadrants. Adhesions were found in 43 quadrants (12 in the RUQ, 6 in the LUQ, 14 in the RIF, and 11 in the LIF) in 21 patients at surgery. Reduced SRSL detected fibrous adhesions in 6 of 15 quadrants, but only 3 of 28 fibrinous adhesions, with an overall sensitivity of 21%, specificity of 94%, and accuracy of 76%. MCSL detected 9 of 15 fibrous and 9 of 28 fibrinous adhesions, with an overall sensitivity of 42%, specificity of 73.5%, and accuracy of 62%. ESL detected 6 of 15 fibrous and 3 of 28 fibrinous adhesions, with an overall sensitivity of 20%, specificity of 76%, and accuracy of 63%. Preliminary results suggest that ultrasound can detect adhesions preoperatively, but the overall sensitivity is poor and the number of false-positives and false-negatives make it unreliable for routine use.

Adult↗
PubMedDate not supplied

Logistic regression when binary predictor variables are highly correlated.

Standard logistic regression can produce estimates having large mean square error when predictor variables are multicollinear. Ridge regression and principal components regression can reduce the impact of multicollinearity in ordinary least squares regression. Generalizations of these, applicable in the logistic regression framework, are alternatives to standard logistic regression. It is shown that estimates obtained via ridge and principal components logistic regression can have smaller mean square error than estimates obtained through standard logistic regression. Recommendations for choosing among standard, ridge and principal components logistic regression are developed. Published in 2001 by John Wiley & Sons, Ltd.

Computer Simulation↗
PubMedDate not supplied

Emergency air transport of pregnant patients: the national experience.

There is considerable debate as to the appropriate role of helicopter transfer of sick patients. The debate over helicopter transfer of high-risk obstetric patients is even more intense. There is clear evidence that high-risk neonates are more likely to survive when they are delivered in a perinatal center compared with local delivery followed by transfer. On the other hand, there is concern that in-flight delivery entails "extreme risks, both to mother and child." In spite of this debate, there has been little research into the frequency of delivery during transport to a hospital or into the mortality associated with such a delivery. A study involving a single center suggests that the incidence of in-flight delivery is very low. We contacted all American Society of Hospital-Based Emergency Air Medical Services (ASHBEAMS) member air ambulance programs to determine the national statistics for in-flight delivery and associated perinatal mortality. We found no instances of in-flight delivery in 357 helicopter transports; 315 of these women were in active labor at the time of transport and 72 were in the accelerated phase of labor. There is evidence that these flights were screened for safety. Airplane flights generally took more time than helicopter flights (P less than .05), and there was one in-flight delivery during 88 airplane transfers. Also presented are additional data that suggest in utero transport of high-risk fetuses to a perinatal center by helicopter is cost effective.

Adolescent↗
PubMedDate not supplied

Substance dependence and eating disorders: impact of sequence on comorbidity.

There is a high comorbidity between eating disorders and substance dependence. The sequence of illness may indicate differences in the underlying pathology and could reflect different etiologies and treatment. The present study subjects were 218 inpatients and outpatients with diagnoses of anorexia nervosa binge-purge type (AN-BP), bulimia nervosa (BN), and eating disorder NOS (ED-NOS). Of these 218 patients, 38 had substance dependence predating the eating disorder (SDED), 71 had an eating disorder predating the substance dependence (EDSD), and 109 had only an eating disorder (ED-only). All subjects were administered the Structured Clinical Interview for DSM-III-R, Patient Edition With Psychotic Screen (SCID-P). EDSD patients had an earlier onset of the eating disorder than SDED patients and had the greatest prevalence of comorbid pathology. SDED patients were dependent on more substances. We conclude that the sequence of development of the eating disorder and substance dependence in eating disorder patients influences the amount of comorbid psychopathology. Clinical implications and future research are discussed.

Adult↗
PubMedDate not supplied

Primary care patients' opinions regarding the importance of various aspects of care for depression.

The objectives of this study were to 1) ascertain the importance of various aspects of depression care from the patient's perspective and 2) select items and scales for inclusion in a new instrument to measure primary care patients' attitudes toward and ratings of depression care. We used a cross-sectional survey at a university-based urban primary care clinic; the subjects were adult patients being recruited for a study of minor depression. To help prioritize attitudinal domains, including 126 items identified previously in focus groups, we asked patients to rate the importance of each aspect of depression care on a five-point scale. Items were ranked according to mean scores and the percentage of patients ranking the items as extremely important. The items were selected for inclusion in an instrument to measure patients' attitudes toward depression care based on their importance ratings. We performed reliability and validity testing of scales comprising the 30 most important items and a shortened version that includes 16 items. The sample included 76 patients (mean age 34.8 years; mean CES-D score, 22.2; 72% women; 36% African-American; 32% college graduates). Forty-six percent had visited a mental health professional in the past. The top 30 items for the overall sample came from the following domains: 1) health care providers' interpersonal skills, 2) primary care provider recognition of depression, 3) treatment effectiveness, 4) treatment problems, 5) patient understanding about treatment, 6) intrinsic spirituality, and 7) financial access to services. Scales comprising items from these domains show adequate internal consistency (Cronbach's alpha >0.70) as well as convergent and discriminant validity. We have designed a brief patient-centered instrument for measuring attitudes toward depression care that has evidence for internal item consistency reliability and discriminant validity.

Adult↗
PubMedDate not supplied

Factors associated with symptomatic improvement and recovery from major depression in primary care patients.

This article describes a post-hoc analysis of clinical and psychosocial factors and beliefs about health associated with treatment outcome in a sample of depressed primary care patients (N=181) randomly assigned to a standardized treatment or physician's usual care (UC). Different factors were found to predict clinical outcomes for treatment modality [UC vs. interpersonal psychotherapy (IPT) or nortriptyline (NT)] and the type of outcome evaluated (i.e., depressive symptoms at 8 months or symptomatic and functional recovery at 8 months). Factors associated with treatment-specific outcomes are also described. Consistent with prior studies, lower depressive symptom severity at 8 months was associated with higher baseline functioning, minimal medical co-morbidity, race, and standardized pharmacologic or psychotherapeutic treatment. Additionally, an interaction between treatment modality and health locus of control indicated that individuals perceiving more self-control of their health and who received a standardized treatment experienced greater depressive symptom reduction at 8 months. Factors associated with symptomatic and functional recovery from the depressive episode were also examined. Patients who received a standardized treatment (IPT or NT) perceived greater control of their health and lacked a lifetime generalized anxiety disorder or panic disorder were more likely to recover by month 8 than those who received usual care. While clinical severity and treatment adequacy play an important role in both symptomatic improvement and full recovery from a depressive episode, other key factors such as health beliefs and non-depressive psychopathology also influence recovery.

Adolescent↗
PubMedDate not supplied

The association of depression and problem drinking: analyses from the Baltimore ECA follow-up study. Epidemiologic Catchment Area.

In this study, we hypothesized that there would be an increased risk of greater alcohol consumption among depressed problem drinkers than those without depression in the prior year, and that the strength of this association would be stronger for women. As part of the Epidemiologic Catchment Area (ECA) program, probability samples of area residents were selected and the baseline interview for the Baltimore site was completed in 1981. Between 1993 and 1996, 73% of the survivors (n = 2633) were reinterviewed. For the 334 problem drinkers identified, the occurrence of a depressive episode and level of alcohol consumption for each intervening year between the baseline and follow-up interviews were assessed. Generalized estimating equations (GEE) were used for logistic regression analyses to examine the association between the occurrence of depression in the prior year with transition to higher-level drinking in the subsequent year. The problem drinkers tended to have a bimodal association of transitioning to higher-level drinking; although the strength of the association was greater for men. Future research will need to assess the potential influences on this relationship of other sociodemographic and psychopathologic characteristics, including the effect of treatment for depression or substance use.

Adolescent↗
PubMedDate not supplied

Versatile expression system for rapid and stable production of recombinant proteins.

Previously we reported the development of a novel expression system with Tat/TAR-oriP vectors and HKB11 cell line, which supports high level protein expression (Cho et al. Cytotechnology 2001, 37, 23-30). In the present study, we further demonstrated that HKB11 cells are suitable for high throughput expression (microgram scale) of genomic candidates in transient transfection system for in vitro evaluation of biological functions. HKB11 cells were also shown to support the production of milligram to gram quantities of protein drug candidates for in vivo evaluation of efficacy in various disease models. Stable HKB11 clones secreting high levels of a tissue factor (TF; 40-50 pg/c/d) and B-domain deleted recombinant factor VIII (BDDrFVIII; 5-10 microU/c/d) were derived under serum-free conditions. The specific productivity for these two proteins from the HKB11 cells was 10-fold greater than those from CHO cells derived under the similar conditions. In conclusion, we have demonstrated that the HKB11 cell line is well-suited for transient and long-term production of recombinant proteins.

Animals↗