Search PubMed⌕ Search

Biomedical subjects

D Daniels

Publications and source records attributed to D Daniels.

At least 19 recordsLinked to original sources
PubMed2000

National, state, and urban area vaccination coverage levels among children aged 19-35 months--United States, 1998.

PROBLEM/CONDITION: High vaccination levels in the population are necessary to decrease disease transmission and prevent disease; therefore, an important component of the U.S. vaccination program is the assessment of vaccination coverage. Current goals are for > or = 90% coverage with recommended vaccines during the first 2 years of life. REPORTING PERIOD: January-December 1998. DESCRIPTION OF SYSTEMS: The National Immunization Survey (NIS) is an ongoing, random-digit-dialed telephone survey that gathers vaccination coverage data for children aged 19-35 months in all 50 states and 28 urban areas. Vaccination coverage rates derived from NIS data are adjusted statistically for households with multiple telephone lines, household nonresponse, the proportion of households without telephones, and vaccination provider nonresponse. The results were also adjusted to match the known total population of children in each survey area. RESULTS: On the basis of NIS data, national coverage was > or = 90% for three doses of poliovirus vaccine (Polio), three doses of Haemophilus influenzae type b vaccine (Hib), and one dose of measles-containing vaccine (MCV). Coverage was the highest ever reported for four doses of any diphtheria and tetanus toxoids and pertussis vaccine (DTP) (i.e., diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and tetanus toxoids [DT], or diphtheria and tetanus toxoids and acellular pertussis vaccine [DTaP]) (83.9%), three doses of hepatitis B vaccine (Hep B, 87.0%), and one dose of varicella vaccine (43.2%). The number of states achieving the > or = 90% goal was 47 for three doses of Hib, 40 for three doses of Polio, 40 for one dose of MCV, nine for three doses of Hep B, and seven for four doses of DTP. Proportionally fewer urban areas achieved the > or = 90% goal: 23 of 28 for three doses of Hib, 13 for three doses of Polio, 16 for one dose of MCV, five for three doses of Hep B, and one for four doses of DTP. No state or urban area has yet achieved the > or = 90% goal for varicella. INTERPRETATION: Findings from the 1998 NIS indicate that national vaccination coverage levels for routinely recommended childhood vaccines are at the highest levels ever reported. However, substantial variation in coverage remains at the state and urban area levels. PUBLIC HEALTH ACTIONS: The public health community and vaccination providers in areas with low coverage should intensify their efforts to implement recommended strategies for increasing vaccination coverage to ensure that children are equally well protected throughout the United States.

Child, Preschool↗
PubMed2000

Air quality and pediatric emergency room visits for asthma in Atlanta, Georgia, USA.

Pediatric emergency room visits for asthma were studied in relation to air quality indices in a spatio-temporal investigation of approximately 130,000 visits (approximately 6,000 for asthma) to the major emergency care centers in Atlanta, Georgia, during the summers of 1993-1995. Generalized estimating equations, logistic regression, and Bayesian models were fitted to the data. In logistic regression models comparing estimated exposures of asthma cases with those of the nonasthma patients, controlling for temporal and demographic covariates and using residential zip code to link patients to spatially resolved ozone levels, the estimated relative risk per 20 parts per billion (ppb) increase in the maximum 8-hour ozone level was 1.04 (p < 0.05). The estimated relative risk for particulate matter less than or equal to 10 microm in aerodynamic diameter (PM10) was 1.04 per 15 microg/m3 (p < 0.05). Exposure-response trends (p < 0.01) were observed for ozone (>100 ppb vs. <50 ppb: odds ratio = 1.23, p = 0.003) and PM10 (>60 microg/m3 vs. <20 microg/m3: odds ratio = 1.26, p = 0.004). In models with ozone and PM10, both terms became nonsignificant because of collinearity of the variables (r= 0.75). The other analytical approaches yielded consistent findings. This study supports accumulating evidence regarding the relation of air pollution to childhood asthma exacerbation.

Adolescent↗
PubMed2000

Rapid assessment and response to injecting drug use in Madras, south India.

HIV infection among injecting drug users (IDUs) is preventable, and in order to develop appropriate interventions, an assessment was carried out at Madras, South India using the Rapid Assessment and Response Guide on Injecting Drug Use developed by WHO. Data were collected with multiple methods from multiple sources using the principles of triangulation and induction. A total of 100 IDUs were interviewed. These interviews were complemented by focus groups and observations. A community advisory board ensured community ownership and participation. Findings showed that heroin, buprenorphine, diazepam and avil were the drugs most commonly injected. The use of pharmaceutical preparations as a 'cocktail' was also prevalent. Drug injectors interviewed were males, and most (81%) were from low-income groups living in slums. Direct (69%) as well as indirect sharing (94%) was common. Such unhygienic injecting practices, and the lack of access to sterile water, contribute to the high incidence of adverse health consequences. Compared with the buprenorphine injectors, heroin injectors were more likely to share injecting equipment (P=0.0022), inject more frequently (P=0.0013), have more drug using network members (P=0.0104), frequent 'shooting' locations (P=0.002), use the dealer's place to inject (P=0.0317), and face threats of arrest (P=0.0023). Many buprenorphine injectors managed their life without serious crises, and seemed to adopt a 'natural' harm reduction response. Sexual risk behaviour was prevalent among opioid users, and a history of commercial sex was associated with daily alcohol use (P=0.0221). The assessment led to an action plan which was presented and endorsed in an advocacy meeting by key stake-holders and decision-makers. The critical importance of implementing quality, accessible, community-oriented, and effective HIV interventions with the capacity to reach the majority of IDUs is discussed. Public health responses to injecting drug use must target changes among individuals at-risk, as well as in the community and risk environment.

Journal Article↗
PubMed2000

Functionally-defined compartments of the lordosis neural circuit in the ventromedial hypothalamus in female rats.

Sexual behavior in female rats, typified by the lordosis reflex, is dependent upon estrogen action in the ventromedial nucleus of the hypothalamus (VMH) and its surrounding neuropil. However, the synaptic organization of this brain region remains unclear. Pseudorabies virus (PRV) was used to transneuronally label the neural network that innervates the lumbar epaxial muscles that execute the lordosis response. PRV-labeled neurons were identified within and subjacent to the VMH four days after injection of PRV into the back muscles. The pattern of labeling was defined in relation to three landmarks: the VMH core, as defined by Crystal Violet staining; the shell, as defined by the oxytocin fiber tract; and the cluster of estrogen receptor-containing cell nuclei. The pattern of PRV labeling in the VMH displayed a striking rostral-caudal gradient. In general, many of the PRV-labeled neurons were found in the oxytocin fiber tract, with far fewer in the core of the VMH. Furthermore, PRV-labeled neurons were rarely found in the cluster of estrogen receptor-containing neurons, and less than 3% of the PRV-labeled neurons were double labeled for estrogen receptor. The results suggest that oxytocin may directly influence these lordosis-relevant VMH projection neurons, whereas estrogen may have transsynaptic effects.

Animals↗
PubMed1999

Author errata.

Explore the source record for details and available documents.

Retraction Notice↗
PubMed1999

Central neuronal circuit innervating the lordosis-producing muscles defined by transneuronal transport of pseudorabies virus.

The lordosis reflex is a hormone-dependent behavior displayed by female rats during mating. This study used the transneuronal tracer pseudorabies virus (PRV) to investigate the CNS network that controls the lumbar epaxial muscles that produce this posture. After PRV was injected into lumbar epaxial muscles, the time course analysis of CNS viral infection showed progressively more PRV-labeled neurons in higher brain structures after longer survival times. In particular, the medullary reticular formation, periaqueductal gray (PAG), and ventromedial nucleus of the hypothalamus (VMN) were sequentially labeled with PRV, which supports the proposed hierarchical network of lordosis control. Closer inspection of the PRV-immunoreactive neurons in the PAG revealed a marked preponderance of spheroid neurons, rather than fusiform or triangular morphologies. Furthermore, PRV-immunoreactive neurons were concentrated in the ventrolateral column, rather than the dorsal, dorsolateral, or lateral columns of the PAG. Localization of the PRV-labeled neurons in the VMN indicated that the majority were located in the ventrolateral subdivision, although some were also in other subdivisions of the VMN. As expected, labeled cells also were found in areas traditionally associated with sympathetic outflow to blood vessels and motor pathways, including the intermediolateral nucleus of the spinal cord, the paraventricular hypothalamic nucleus, the red nucleus, and the motor cortex. These results suggest that the various brain regions along the neuraxis previously implicated in the lordosis reflex are indeed serially connected.

Animals↗
PubMed1999

Observations on labor epidural analgesia and operative delivery rates.

OBJECTIVE: Our purpose was to compare operative vaginal and abdominal delivery rates in a large population before and after on-demand labor epidural analgesia became available. STUDY DESIGN: We retrospectively compared patients who gave birth during a 20-month period immediately before the introduction of an on-demand labor epidural analgesia service with those who gave birth during a 20-month period after the epidural usage rate had reached a plateau at approximately 60%. Operative vaginal and cesarean delivery rates were stratified according to parity and history of prior cesarean delivery. RESULTS: A total of 4859 women gave birth during the study period when on-demand epidural analgesia was available, and 4778 women gave birth in the study period before the availability of on-demand epidural analgesia. Comparisons between the women with and those without on-demand availability of epidural analgesia demonstrated no statistically significant differences in the rate of spontaneous vaginal delivery (69.5% vs 68.3%), the overall cesarean delivery rate (19.0% vs 19.4%), the primary cesarean delivery rate (13.2% vs 13.4%), or the operative vaginal delivery rate (11.1% vs 11.9%) between the 2 periods. There were no statistically significant differences in mean gestational age at the time of delivery between the 2 groups, whereas there were statistically significant increases in the proportion of nulliparous women and in mean birth weight during the on-demand epidural period. Analysis after substratification of the study groups according to parity also revealed no statistically significant differences in the primary cesarean delivery rate or the proportion of women undergoing vaginal delivery. The sample size was adequate to exclude a 2% increase in the primary cesarean delivery rate between the 2 periods with 80% power. Subgroup analysis of the population of women who gave birth while epidural analgesia was available on request demonstrated that nulliparous parturient women who requested epidural analgesia were almost twice as likely to require operative vaginal or cesarean delivery as women who did not request epidural analgesia, a finding suggesting that women who request labor epidural analgesia have an inherent propensity toward operative delivery. CONCLUSION: The introduction of an on-demand labor epidural analgesia service does not increase the rate of cesarean delivery or operative vaginal delivery.

Adult↗
PubMed1998

A prospective randomized trial of the use of epidural anesthesia during external cephalic version.

Objective: To determine if the use of epidural anesthesia improves the success rate of external cephalic version (ECV).Design: Women identified with a singleton fetus in a breech or transverse presentation at a gestational age of >/=37 weeks gestation were offered enrollment in this prospective randomized trial. Inclusion criteria included maternal age of 18 years or older, a non-vertex presentation confirmed by ultrasound, a reactive fetal non-stress test, and an estimated fetal weight of 2,000-4,000 g. A 1:1 randomization was accomplished through a computer-generated random numbers table with group assignments sealed in sequentially numbered opaque envelopes. Women in the epidural ECV group had a lumbar epidural catheter inserted through which 2% lidocaine and 100 µg of fentanyl were infused.Results: There were no statistically significant differences between the two groups in gestational age at ECV, placental location, fetal lie, gravidity or parity, estimated fetal weight, or amniotic fluid index. The ECV was successful in 26 of 45 (58%) women with epidural anesthesia compared to 16 of 48 (33%) with no anesthesia (relative risk 1.7, 95% confidence interval 1.1-2.8, P <.05). Fetal bradycardia resulting in discontinuation of the version efforts occurred in two patients in the epidural group and three women in the control population, a non-statistically significant difference. There were no maternal complications noted in the study population related to the epidural anesthesia.Conclusions: The use of epidural anesthesia increases the success rate of external cephalic version.

Journal Article↗
PubMed1998

A potent protein-tyrosine kinase inhibitor which selectively blocks proliferation of epidermal growth factor receptor-expressing tumor cells in vitro and in vivo.

A calculated 3-D model of the kinase domain of the epidermal growth factor receptor (EGF-R) protein-tyrosine kinase (PTK) was used to develop a pharmacophore model for ATP-competitive inhibitors and, subsequently, a new class of selective EGF-R kinase inhibitors. CGP 59326A, a highly selective and potent inhibitor of the EGF-R in vitro, inhibited the proliferation of EGF-R-expressing epithelial lines, while having little anti-proliferative activity against EGF-R-negative lines. In contrast to previously described inhibitors, CGP 59326A had potent and selective in vivo anti-tumor activity at well-tolerated doses against EGF-R-expressing tumors (e.g., ED50 of 0.78 to 1.5 mg/kg for inhibition of A431 tumor growth). CGP 59326A inhibited growth of human tumor xenografts expressing the EGF-R but showed little activity against EGF-R-negative xenografts. Combination of CGP 59326A with cytotoxic agents resulted in tumor regression and cures. The high selectivity and attractive biological profile of CGP 59326A suggest that it could have therapeutic value in the treatment of proliferative diseases which involve mitogenic signaling from the EGF-R.

3T3 Cells↗
PubMed1998

Community-based outreach HIV intervention for street-recruited drug users in Madras, India.

OBJECTIVE: Community-based outreach to drug injectors is an important component of human immunodeficiency virus (HIV) prevention strategy. The purpose of this chapter is to evaluate the effectiveness of community-based outreach HIV intervention that has been implemented in two locations in the city of Madras, India, to reduce risk behaviors for HIV transmission. METHODS: Baseline data were collected for street-recruited injecting drug users (IDUs) at two outreach locations in Madras, India (n = 250), and follow-up data are available at 18 months (n = 61). Baseline (n = 150) and follow-up data (n = 87) were obtained from control group of IDUs recruited from locations at which outreach services were not utilized. RESULTS: Significant decline in injecting risk behavior was noted at 18-month follow-up from baseline for the IDUs recruited from outreach locations. CONCLUSION: Results indicate that outreach service for drug users produce significant changes in injecting risk behavior but that sexual risk behavior is difficult to change. There are problems in implementing and evaluating the interventions, and the research findings are limited because HIV serodata were not studied for all participants.

Adolescent↗
PubMed1995

Can we distinguish between benign versus malignant compression fractures of the spine by magnetic resonance imaging?

STUDY DESIGN: The authors investigate the usefulness of magnetic resonance imaging in differentiating benign versus malignant compression fractures by reviewing patients and a fracture model in a canine model. OBJECTIVES: To determine the sensitivity and specificity of magnetic resonance imaging in differentiating benign versus malignant compression fractures of the spine and to obtain distinguishing features in magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: The differentiation between benign and abnormal compression fractures of the thoracolumbar spine has important implications regarding patient treatment and prognosis. Plain radiographs, bone scans, and computed tomography are not accurate imaging modalities for this purpose. METHODS: Magnetic resonance imaging scans of 22 patients with confirmed lesions of the thoracolumbar spine were studied. There were 11 malignant and 11 benign lesions. Two experienced neuroradiologists blindly reviewed the magnetic resonance imaging scans and determined benign or malignant lesions. A canine study was performed to simulate a compression fracture model with a vertebral osteotomy in two dogs, and serial contrast-enhanced magnetic resonance imaging scans were performed 15, 30, 60 and 90 days after surgery. RESULTS: The correct interpretation between two neuroradiologists was 77% and 95%. The combined sensitivity rate was 88.5%, and the specificity rate was 89.5%. Magnetic resonance imaging reliably distinguished benign versus malignant lesions based on the anatomic distribution and intensity of signal changes of bone and adjacent tissues, contrast enhancement characteristics, and changes over time. Only one malignant lesion was misinterpreted by both neuroradiologists as benign, whereas there was one additional missed malignant lesion and three misinterpreted benign lesions by one radiologist. In the canine study, signal changes and enhancement were found 60 days after surgery, but no signal changes or enhancement were noted on the scan 90 days after surgery. CONCLUSIONS: Magnetic resonance imaging scans can detect malignant vertebral lesions early, but acute healing compression fractures may mimic the findings of metastatic lesions. The use of contrast-enhanced magnetic resonance imaging scans and serial magnetic resonance imagings are helpful for additional differentiation between benign and malignant compression fractures. In addition to magnetic resonance imaging scans, other diagnostic tests and clinical findings should be correlated before biopsy or surgery of the suspected lesion.

Adult↗
PubMed1994

Organ donation in the Hispanic population: dondé estan ellos?

Few studies have investigated organ donation among Hispanics, although in major US cities, Hispanics, like African Americans, make up a large percentage of the general population. In fact, the 1990 census reports that of all Hispanics in the country, 90% live in urban areas. The tendency for Hispanics to use hospital emergency rooms rather than visit a physician's office may result in an inadequate exchange of information between minority patients and health-care providers. Hospitals that serve minority populations have been reported to have the lowest organ procurement rates. These hospitals are often funded by local, county, or state funds and are usually dedicated to a patient mix that is largely indigent. The heavy work load of health-care providers who often have limited resources does not lend itself to an adequate exchange of information between patients and health-care providers. The existence of this type of environment impacts on patient communication, increases the fear of complication, and may diminish the discussion of potential organ procurement. There are multiple individual and structural reasons for the high family refusal rates among Hispanics. Procurement specialists may see a proportionally small number of Hispanic families, mainly due to a lack of referrals from hospital staff concerning possible Hispanic donors. White procurement workers may not be familiar with the Hispanic family makeup and cultural attitudes. Organ procurement workers may not pursue the issue of donation with Hispanic families as much as they do with white families. Whatever the reason, if we are to increase organ donation in the Hispanic community, these complex issues will need to be addressed.

Hispanic or Latino↗
PubMed1992

The spontaneous regression of lymphoma in AIDS.

Non-Hodgkin's lymphomas are an increasing problem in the AIDS population. They are generally aggressive, high-grade lymphomas and more commonly present at extranodal sites, particularly the central nervous system. Although chemo- and radiosensitive, the duration of response is generally short lived. Spontaneous remission of non-Hodgkin's lymphomas has been reported in immunocompetent individuals, but has not been reported in HIV disease. We would like to report the first such case.

Acquired Immunodeficiency Syndrome↗