Search PubMed⌕ Search

Biomedical subjects

D A Miller

Publications and source records attributed to D A Miller.

At least 73 records · Page 4Linked to original sources
PubMed1995

Cesarean birth: how to reduce the rate.

The cesarean section rate, which approached 25%, has stabilized and started a modest decline. A stated United States national goal by the year 2000 is a rate of 15%. Suggested rates are 12% for primary and 3% for repeat cesarean sections. The major indications for cesarean section are prior cesarean delivery (8%), dystocia (7%), breech presentation (4%), fetal distress (2% to 3%), and others. The major areas of reduction must occur in the categories of prior cesarean delivery and dystocia. An expanded use of trial of labor and vaginal birth after a prior cesarean section will produce further reductions. Countries in Europe achieve > 50% vaginal birth after a prior cesarean section compared with 25% in the United States. A heightened awareness must occur regarding the decision to perform the first cesarean section. The residual impact, a scarred uterus, affects 12% to 14% of women seen for delivery. Even if 50% achieve a vaginal birth after a prior cesarean section, the national goals are unachievable. The obstetrician must consciously consider the impact of "once a cesarean, always a scar."

Cesarean Section↗
PubMed1995

Nonstress test.

Explore the source record for details and available documents.

Amniocentesis↗
PubMed1995

Coming of age in hard times.

Young people are facing very serious problems of unemployment and underemployment in the current job market. Disadvantaged youth are enduring the most difficult struggle. One plausible reason is that youth are undereducated and insufficiently skilled to meet job requirements. This article explores forty in-depth interviews with young people from three high-unemployment neighborhoods to closely examine experiences in high school and in the post-high school work entry phase. The purpose was to determine whether the youths were receiving the skill set components advanced by Comprehensive Collaborative Models. Policy implications are drawn from the lack of fit between model prescriptions and actual experiences.

Adolescent↗
PubMed1994

Seven genes on the short arm of human chromosome 3 map to two regions on Macropus eugenii (tammar wallaby) chromosome 2.

Seven genes were mapped by in situ hybridization to metaphase chromosomes of the marsupial species Macropus eugenii, using a series of human-derived cloned probes (six cosmids and one cDNA). The genes were located in two widely separated clusters on the long arm of M. eugenii chromosome 2, in contrast to their location in a single cluster on the distal half of the short arm of human chromosome 3. Multiple rearrangements had to be involved in the evolutionary divergence of these chromosome segments from the unknown arrangement in the common ancestor.

Animals↗
PubMed1994

Expression of transforming growth factor-beta mRNAs and proteins in pulmonary vascular remodeling in the sheep air embolization model of pulmonary hypertension.

Transforming growth factor-beta (TGF-beta) has been suggested as one of the mediators of vascular remodeling in chronic pulmonary hypertension. We have previously shown a transient early increase in TGF-beta levels in lung lymph during the development of sustained pulmonary hypertension in a sheep model (12 days of air embolization). The present study examines expression and cellular localization of mRNA and protein of the three mammalian isoforms of TGF-beta in lung biopsy tissue taken during the development of pulmonary hypertension (0, 1, 4, 8, and 12 days of embolization). In control tissue, immunohistochemical techniques localized each of the TGF-beta proteins in an identical pattern in large preacinar airways--bronchial epithelium and subepithelial cells--and in the medial wall of muscular vessels; no protein was detected in intraacinar regions. Following air embolization, immunoreactivity appeared in peripheral lung. At day 1, immunoreactivity for TGF-beta 1 and TGF-beta 3 proteins was seen in edema fluid, in perivascular cells associated with nonmuscular intraacinar arteries, and in alveolar walls; no increased immunoreactivity was detected for TGF-beta 2. After 4, 8, and 12 days of embolization, immunoreactivity for all three TGF-beta proteins was associated with newly muscularized intraacinar arteries. With in situ hybridization, the three TGF-beta mRNAs co-localized in lung tissue from both control and air-embolized animals. In control tissue, hybridization was seen around preacinar airways and muscular vessels; no hybridization seen in intraacinar regions of the lung. After 1 day of embolization, the pattern of hybridization was similar to controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Vaginal birth after cesarean: a 10-year experience.

OBJECTIVE: To report the changing incidence of previous cesarean delivery, and the increasing use and success of a trial of labor and its effect on the repeat cesarean rate. METHODS: Between 1983-1992, there were 164,815 deliveries at Los Angeles County+University of Southern California Women's Hospital, of which 17,322 (10.5%) were to women with at least one previous cesarean delivery. Data were gathered on an ongoing basis from delivery logs and patient charts. RESULTS: Women with at least one previous cesarean accounted for 8.1% of all deliveries in 1983, increasing to 14.1% by 1992. Trial of labor was used in 80% of women with one previous cesarean, in 54% with two, and in 30% with three or more. The success rate was significantly higher with one previous cesarean (83%) than with two or more (75.3%). Furthermore, uterine rupture was three times more common with two or more previous cesareans. Compared to a policy of routine repeat cesarean, trial of labor yielded a 6.4% lower cesarean delivery rate. The majority of this benefit (5.5%) was derived by women with one previous cesarean. Among women undergoing a trial of labor, there were three rupture-related perinatal deaths and a single rupture-related maternal death. CONCLUSION: Substantial reduction in the cesarean rate is achieved safely and efficiently by encouraging a trial of labor in women with a single previous cesarean delivery.

Cesarean Section↗