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Biomedical subjects

C Riley

Publications and source records attributed to C Riley.

At least 19 recordsLinked to original sources

Managed care education in osteopathic medical schools: development of a fourth-year predoctoral healthcare management clerkship.

This article describes the current managed care curricula in osteopathic medical schools and summarizes the development and implementation of a healthcare management clerkship for fourth-year osteopathic medical students at Ohio University College of Osteopathic Medicine. Results of a survey of the 19 osteopathic medical schools indicated that only three schools currently have a stand-alone, managed care elective. No schools have required managed care courses, clerkships, or rotations. The remaining osteopathic medical schools have incorporated managed care-related topics into courses in their schools' curricula. To produce physicians fully competent to succeed in the 21st century's managed healthcare environment, medical schools need to affiliate with managed care organizations, integrate more managed care components into their curricula, and develop required or elective stand-alone managed care courses and clerkships. This article describes content to be integrated in a predoctoral managed care clerkship, including goals and objectives. It also describes the components and learning activities of Ohio University College of Osteopathic Medicine's Healthcare Management Clerkship.

Clinical Clerkship↗

Electrodeposition of brushite coatings and their transformation to hydroxyapatite in aqueous solutions.

In this study we examine the potential for using brushite (dicalcium phosphate dihydrate) as a coating for orthopedic implants. It was found that brushite is transformed into a more stable calcium phosphate (hydroxyapatite), regardless of the aqueous transforming media utilized. The transformation was carried out at room temperature in deionized water, deionized water with added calcium ions, and modified Hank's type solution without calcium and magnesium ions, modified Hank's type solution with calcium and magnesium ions, and modified Hank's type solution with added calcium ions. In several of the transformation systems it was noted that brushite provided an increased amount of calcium ions to the transforming media through solubility. The process was monitored using X-ray diffraction, X-ray photoelectron spectroscopy, and dissolution studies. Scanning electron microscopy and energy dispersive spectroscopy were also utilized for characterization. The brushite coatings can be easily achieved electrolytically on conducting substrates. The process is non line of sight, simple, and inexpensive; and when using an electrolyte that can sustain currents of approximately 100 mA/cm2, the necessary coating can be completed in about 3 min.

Calcium Phosphates↗

Transformation of modified brushite to hydroxyapatite in aqueous solution: effects of potassium substitution.

Brushite (dicalcium phosphate dihydrate, DCPD, CaHPO4 x 2H2O) was deposited electrolytically from calcium dihydrogen phosphate solution with and without potassium chloride (KCl) as a supporting electrolyte. The kinetics of brushite transformation to hydroxyapatite (HA, Ca5(PO4)3OH) in the presence of calcium and protein free, aqueous body fluid (Hank's balanced salt solution, HBSS) was investigated. We present evidence that the deposition of brushite in a KCl-supported electrochemical bath yields a modified brushite where some of the calcium is substituted by potassium. Transformation of both normal (i.e. potassium free) and modified brushite to hydroxyapatite upon exposure to calcium and protein-free aqueous fluid (HBSS) was followed by reflectance Fourier Transform Infrared (FTIR) spectroscopy and X-ray diffraction (XRD) techniques. Changes in the morphology of the coatings were studied using scanning electron microscopy (SEM). Results indicate that modified brushite undergoes faster transformation to hydroxyapatite in HBSS in comparison to normal brushite. Our results show that the presence of potassium ions in the brushite not only favors the formation of different intermediate phases but also alters transformation rates to HA.

Calcium Phosphates↗

The effect of chlorambucil upon lysozyme activity.

Chicken egg white lysozyme is progressively inhibited by diazoacetyl-DL-norleucine methyl ester (DANME) and by chlorambucil at concentrations of 3.4 x 10(-3) M and 5 x 10(-3) M respectively over a three-hour time period. DANME inhibits lysozyme activity to the extent of 87%, and chlorambucil inhibits the enzyme to the extent of 93%. N,N',N"-triacetylchitotriose [(NAG)3], which binds to subsites A, B and C of the enzyme protects lysozyme from DANME inhibition to the extent of 40% of the total activity when added to the enzyme at a concentration of 3.6 x 10(-3) M prior to the addition of DANME. (NAG)3 protects the enzyme from inhibition by chlorambucil to the extent of 14% of the total activity when added to the enzyme at a concentration of 5.6 x 10(-3) M prior to the addition of chlorambucil. Since DANME reacts exclusively with carboxyl groups, and since aspartic acid 101 is required for binding the carbohydrate substrate at site A, it is suggested that (NAG)3 may bind reversibly to the active site of the enzyme, thereby protecting aspartic acid 101 from esterification by DANME and subsequent inactivation. Chlorambucil, which may react with carboxyl, amino, imidazole and thiol groups, more likely acts upon a larger number of susceptible sites, thereby causing irreversible alkylation and conformation changes. As a bifunctional alkylating agent, it may also cross-link with two available nucleophiles. The K(m) for lysozyme with M. lysodeikticus as a substrate in wholly aqueous medium was determined to be 0.05 mg/mL. The inhibitor exhibits a partially uncompetitive upon pre-incubation with the enzyme, and a mixed inhibition between competitive and noncompetitive when pre-incubated with the substrate.

Animals↗

A cross-cultural study of reactivation of posttraumatic stress disorder symptoms: American and Cambodian psychophysiological response to viewing traumatic video scenes.

A physiological hyperarousal state, which can be reactivated by traumatic stimuli, occurs frequently in patients with posttraumatic stress disorder (PTSD). The goals of this study were to determine whether physiological hyperarousal measured by increased heart rate is a specific response to reminders of a patient's own traumatic events or a more generalized hyperarousal state. Five brief videotape scenes of traumatic events (hurricane, auto accident, Cambodian refugee camp, domestic violence, and Vietnam War) were shown to two patient groups with PTSD (Vietnam veterans and Cambodian refugees) and three control groups (Vietnam veterans, Cambodian refugees, and nonpatient Americans). Observations of subjects' behavior, subjective ratings of distress, and heart rate change were recorded and evaluated. The results indicated that Cambodians with PTSD had the most reactions as measured by behavior and heart rate changes. These tended to occur during all scenes, not just the specific Cambodian scene, indicating a general nonspecific arousal. The Vietnam veterans had the fewest changes implying an inhibition of response. The control groups were intermediate in physiological response. The response in PTSD patients to reactivation scenes is complex and probably relates to type and degree of trauma, as well as to culture.

Adult↗

The efficacy of local anaesthetics administered by general dental practitioners.

AIM: To obtain empirical evidence for the efficacy of local anaesthesia in dentistry. DESIGN: Retrospective analysis of serial administrations of local anaesthesia. METHODS: Dentist and patient evaluations of the success of differing techniques (infiltration and block) of anaesthesia in a variety of general practice procedures. Results were analysed for correlation between dentist and patient using a 5-point scale. RESULTS: Complete data were analysed for 331 administrations. In the hands of experienced dentists over 93% of operations were assessed by both dentist and patient as comfortable or completely comfortable. Dentists were generally able to judge patient comfort (P < 0.001). Administrations requiring repeat injections were less comfortable. Dentists judged infiltration administrations more comfortable than block administrations (P < 0.001), but patient judgements of comfort failed to distinguish between differing techniques at the P < 0.05 level. CONCLUSIONS: Some variations in success rate exist between dentists the most dental procedures under local anaesthetic in general practice were assessed as being comfortable or better by both dentists and patients.

Adult↗

Anatomy of an OPTI: Part I. Form, function, and relationships.

In July 1995, the American Osteopathic Association (AOA) Board of Trustees passed new regulations for the accreditation of osteopathic graduate medical education (GME) programs by establishing the Osteopathic Postdoctoral Training Institutions (OPTI) system, to be implemented over 4 years. The resulting changes include requirements for college cosponsorship of GME programs and the establishment of standards for the minimum number of residency programs, interns, and residents. The OPTIs will be subject to AOA inspections at least every 5 years. Proponents of the OPTI system claim it will strengthen the profession by promoting educational collaboration, raising academic standards, and requiring appropriate resources to support osteopathic medical education. Opponents fear that it will be too resource intensive, create an additional layer of unnecessary bureaucracy, and have a negative impact on small colleges, hospitals, and states. Despite the controversy, a process for applying for OPTI status has been developed by the AOA, and a number of hospitals and colleges are already developing OPTIs. This article, the first in a two-part series, identifies issues and barriers to be considered in the formation of OPTIs and articulates principles underlying successful collaborations. In Part 2 these issues, principles, and barriers will be reinforced by describing the process used to form a large OPTI--the Ohio University College of Osteopathic Medicine (OU-COM) Centers for Osteopathic Regional Education (CORE) System.

Accreditation↗

The anatomy of an OPTI: Part 2. The CORE system. Ohio Osteopathic Hospital Association. Ohio Association of Osteopathic Medical Directors. Ohio Osteopathic Association.

In July 1995, the American Osteopathic Association (AOA) Board of Trustees passed new regulations regarding the accreditation of osteopathic graduate medical education (GME) by establishing the Osteopathic Postdoctoral Training Institutions (OPTI) system. This system must be phased in by July 1999. The principal changes resulting from the OPTI system include establishing requirements for college cosponsorship of GME programs and for the number of residency programs, interns, and residents to be trained by the OPTI. In essence, OPTI is an osteopathic acronym for consortium. Each OPTI must include at least one college of osteopathic medicine (COM) and one AOA-accredited hospital. The OPTIs will be subject to interval AOA inspections and will be required to demonstrate a governing system, mission statement, organizational structure, and the presence of faculty development programs. The first article in this two-part series, published in the October JAOA, provided a general blueprint for OPTI building and presented both positive and negative issues germane to the formation of OPTIs. Part 2 reinforces the considerations outlined in Part 1 by describing the formation of a large OPTI--the Ohio University College of Osteopathic Medicine (OU-COM) Centers of Osteopathic Regional Education (CORE) system. Key features are described, including the mission statement, organizational structure, committee system, governance, GME programs, operations, and budget.

Accreditation↗

Hydroxyapatite/metal composite coatings formed by electrocodeposition.

Early bone infusion by cementless fixation of composite orthopedic and dental implants consisting of metallic substrates and bioceramics is well documented. Calcium phosphate ceramics in general and hydroxyapatite (HA) in particular have been the most popular of the bioceramics used for coating metals. Here, a non-line of sight coating procedure by electrocodeposition is reported for mechanically fixing HA particles in a metal matrix. Analyses of the coating showed excellent adhesion to the substrate and no structural transformation in either crystallinity or stoichiometry. Adhesion and surface coverage of HA depended upon the particle size. As a demonstration of the coating procedure's non-line of sight applicability, it was successfully used to coat titanium rods sintered with small titanium spheres.

Biocompatible Materials↗

Videokeratography database of normal human corneas.

AIM: To form a database of videokeratography patterns and quantitative indices describing normal human corneas using the absolute scale. METHODS: Both eyes of 195 normal subjects were examined with a TMS-1 videokeratoscope. Videokeratographs were divided into 10 categories based on a classification scheme devised from the absolute scale and analysed with 10 quantitative indices devised to describe phenotypic features of keratoconus videokeratographs. Correlations were sought between videokeratograph patterns and quantitative indices. Additionally, data were analysed for differences in age, sex, and ethnicity. RESULTS: For symmetric videokeratography patterns, analysis in the absolute scale was similar to a previous study done in the normalised scale. In the asymmetric categories, analyses differed markedly. Using the absolute scale and our classification scheme more variation in normal videokeratography patterns could be appreciated. There was good correlation between quantitative indices and videokeratography patterns. Neither videokeratography patterns nor indices differed significantly between sex, ethnic groups, or age using two way analysis of variance. CONCLUSIONS: Pattern analysis of videokeratographs in the absolute scale using, a standard classification scheme, may be more useful in trying to determine whether a cornea is normal or represents subtle early disease than analysis in the normalised scale. Quantitative indices could remove the subjectivity from the decision making process thus facilitating universal reproducibility of videokeratography data interpretation.

Adult↗

Weekly and yearly rhythms in plasma fibrinogen in hospitalized male military veterans.

The variation in plasma fibrinogen level demonstrating prominent circaseptan and circannual cycles is clinically relevant. There is a correlation between increasing level of fibrinogen and other hemostatic factors and risk of myocardial infarction and sudden death. The circaseptan and circannual cycles in fibrinogen concentration described in this study may help to explain further the variation in frequency of coronary events. Furthermore, the recent demonstration of a circadian pattern in the efficacy of tissue plasminogen activator, with peak efficacy occurring at 2000 hours--10 hours after the peak incidence of myocardial infarction--implies that further patterns to coronary artery syndromes may be predicted and the treatment efficacy may rely on demonstrated circaseptan and circannual cycles of these events.

Adult↗

A comparative study of family functioning among Vietnamese and Cambodian refugees.

This study was designed to determine the extent of family problems among a clinic population of Cambodian and Vietnamese refugees, and to identify similarities and differences between the two groups. All 107 patients with adolescent children from a total clinic population of 298 were interviewed using a semistructured questionnaire, results were tabulated, and statistical methods were applied. The types of problems with children described by parents were classified into the dimensions of communication, personal behaviors, school performance, social behaviors, and antisocial behaviors. There were significantly more problems described by Vietnamese parents as compared with Cambodian parents. Vietnamese parents reported significantly more dissatisfaction with life in the United States. For both ethnic groups, parents' relationships with their adolescent children were a major source of concern and had a major impact on parents' perceptions of their own health. Yet, there were important ethnic differences between these refugee groups in how patients perceived their problems.

Acculturation↗

Ceroid granulomas in the female genital system.

Three cases of ceroid granulomas of the female genital system are presented, involving the cervix in two and lesions in the ovaries and bowel serosa in the other. Ceroid granulomas are unusual and interesting lesions formed when suitable substrates accumulate within macrophages to such an extent that a relative lack of biological antioxidants results and auto-oxidation and conversion to ceroid is favoured. This may occur in the setting of haemorrhage and necrosis, whether from tumour necrosis or associated with endometriosis. Other sources of lipids and lipoproteins include bile, meconium and vernix caseosa.

Aged↗

Analysis of apatite deposits on substrates.

Calcium phosphate coatings, important for medical implant applications can occur in several different phases. Because of differences in properties of these phases it is imperative to be able to identify their presence in a substrate's coating. In this study we characterized hydroxy apatite (HA) surfaces applied by four different coating procedures. Included were plasma sprayed, sputtered, a composite, and a composite overlayed with plasma sprayed. It was found that a combination of reflectance infrared and Raman spectroscopy could be utilized to make an in situ characterization of the calcium phosphate phases. It was shown that plasma sprayed and sputtered coatings of HA lost OH and thus decreased in crystallinity, while composite coatings remained unchanged from the original HA powder.

Biocompatible Materials↗

Periodontal microflora of HIV positive subjects with gingivitis or adult periodontitis.

The subgingival microflora of 39 HIV+ subjects with gingivitis or adult periodontitis was cultured quantitatively anaerobically for bacteria, spirochetes, and mycoplasma and aerobically for yeasts. Isolates were characterized by conventional biochemical tests, polyacrylamide gel electrophoresis of soluble proteins, cellular fatty acid profiles, immunofluorescence, and immunodiffusion. In general, the same types of bacteria were isolated from the subgingival crevice of HIV+ subjects as we previously had isolated from the subgingival crevice of non-HIV subjects. A statistically significant difference was found between the composition of the flora of HIV+ subjects with adult periodontitis (AP) and concurrent studies of a non-HIV+ AP population. Mycoplasma salivarium was significantly elevated in the HIV+ subjects examined. Yeasts were isolated from only 10% of the samples and from 13% of the HIV-positive subjects at 0.05 to 0.0002% of the total cultivable count when present.

Acquired Immunodeficiency Syndrome↗