Respiratory disturbances in air embolism.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
D E Thompson
Publications and source records attributed to D E Thompson.
Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial.
CONTEXT: Alendronate sodium reduces fracture risk in postmenopausal women who have vertebral fractures, but its effects on fracture risk have not been studied for women without vertebral fractures. OBJECTIVE: To test the hypothesis that 4 years of alendronate would decrease the risk of clinical and vertebral fractures in women who have low bone mineral density (BMD) but no vertebral fractures. DESIGN: Randomized, blinded, placebo-controlled trial. SETTING: Eleven community-based clinical research centers. SUBJECTS: Women aged 54 to 81 years with a femoral neck BMD of 0.68 g/cm2 or less (Hologic Inc, Waltham, Mass) but no vertebral fracture; 4432 were randomized to alendronate or placebo and 4272 (96%) completed outcome measurements at the final visit (an average of 4.2 years later). INTERVENTION: All participants reporting calcium intakes of 1000 mg/d or less received a supplement containing 500 mg of calcium and 250 IU of cholecalciferol. Subjects were randomly assigned to either placebo or 5 mg/d of alendronate sodium for 2 years followed by 10 mg/d for the remainder of the trial. MAIN OUTCOME MEASURES: Clinical fractures confirmed by x-ray reports, new vertebral deformities detected by morphometric measurements on radiographs, and BMD measured by dual x-ray absorptiometry. RESULTS: Alendronate increased BMD at all sites studied (P<.001) and reduced clinical fractures from 312 in the placebo group to 272 in the intervention group, but not significantly so (14% reduction; relative hazard [RH], 0.86; 95% confidence interval [CI], 0.73-1.01). Alendronate reduced clinical fractures by 36% in women with baseline osteoporosis at the femoral neck (>2.5 SDs below the normal young adult mean; RH, 0.64; 95% CI, 0.50-0.82; treatment-control difference, 6.5%; number needed to treat [NNT], 15), but there was no significant reduction among those with higher BMD (RH, 1.08; 95% CI, 0.87-1.35). Alendronate decreased the risk of radiographic vertebral fractures by 44% overall (relative risk, 0.56; 95% CI, 0.39-0.80; treatment-control difference, 1.7%; NNT, 60). Alendronate did not increase the risk of gastrointestinal or other adverse effects. CONCLUSIONS: In women with low BMD but without vertebral fractures, 4 years of alendronate safely increased BMD and decreased the risk of first vertebral deformity. Alendronate significantly reduced the risk of clinical fractures among women with osteoporosis but not among women with higher BMD.
Absorptiometry, Photon↗
Genetic interrelationships of proteolytic Clostridium botulinum types A, B, and F and other members of the Clostridium botulinum complex as revealed by small-subunit rRNA gene sequences.
The phylogenetic interrelationships of members of the Clostridium botulinum complex of species was investigated by direct sequencing of their 16S rRNA genes. Comparative analysis of the 16S rRNA sequences demonstrated the presence of four phylogenetically distinct lineages corresponding to: i) proteolytic C. botulinum types A, B, and F, and C. sporogenes, ii) saccharolytic types B, E and F, iii) types C and D and C. novyi type A, and iv) type G and C. subterminale. The phylogenetic groupings obtained from the 16S rRNA were in complete agreement with the four divisions recognised within the the 'species complex' on the basis of phenotypic criteria.
Base Sequence↗
Studies on the large subunit ribosomal RNA genes and intergenic spacer regions of non-proteolytic Clostridium botulinum types B, E and F.
The large-subunit ribosomal ribonucleic acid (23S rRNA) genes of non-proteolytic (group II) strains of Clostridium botulinum toxin types B, E and F were amplified using the polymerase chain reaction (PCR), and cloned in Escherichia coli. Sequence determination showed that the 23S rRNA genes were 2910 nucleotides in length, and comparative analysis revealed approximately 99.5% sequence similarity. The 23S rRNA gene sequence of a strain phenotypically resembling non-proteolytic C. botulinum, except in not producing botulinal neurotoxin, was also determined and displayed 99.5% sequence similarity with those from toxigenic strains. A diagnostic sequence within the 23S rRNA characteristic for non-proteolytic C. botulinum was identified and used for the design of an oligonucleotide probe. Molecular hybridizations with PCR-amplified rDNA targets provided a precise and reliable method of identifying non-proteolytic (or Group II) C. botulinum and closely related non-toxigenic strains.
Base Sequence↗
Evidence that increased calcium intake does not prevent early postmenopausal bone loss.
Calcium's ability to prevent bone loss in early postmenopausal women is controversial. We used data on 394 women from the placebo group of the Early Postmenopausal Interventional Cohort study, a clinical trial of alendronate, to investigate the relation of calcium intake to bone loss. Calcium intake was recorded, and bone mineral density (BMD) (in the lumbar spine, total body, forearm, and hip) and biochemical markers of bone turnover (serum total alkaline phosphatase, serum osteocalcin, and urinary N-telopeptide crosslink levels) were measured at baseline and annually thereafter. Women whose baseline calcium intake was <500 mg/d were advised to increase their calcium intake. Mean (+/- SE) BMD decreased by 1.9% +/- 0.16% at the lumbar spine and 1.6% +/- 0.14% at the hip over the 24-month period. Despite wide variations in baseline calcium intake and changes in calcium intake, these measures were not significantly associated with changes in BMD or bone turnover. Even women whose total calcium intake was >1333 mg/d (the highest tertile of total calcium intake) showed a decline in BMD of almost 2%, similar to declines in the lower two tertiles of total calcium intake (<869 and 869-1333 mg/d, respectively). Increased calcium intake resulted in modest mean increases of approximately 200 mg/d. We were unable to demonstrate that increases of this magnitude or much greater (1 g/d) were protective against declines in BMD at any site, even in women who had the lowest calcium intake at baseline. In addition to adequate calcium intake, more effective therapy appears to be required when the therapeutic goal is to increase or maintain BMD.
Bone Density↗
Dynamic properties of soft tissues and their interface with materials.
Treatment for the human hand involves application of forces and torques to the skeletal system. These are applied through the soft tissues, frequently using protective materials such as splints and other static and dynamic therapeutic orthoses. A view of soft tissues as polymeric materials provides a more universal approach. The role of shear in soft tissues is discussed, as well as the response of the tissues of the hand to the mechanical challenges of treatment. A connection between the underlying concepts presented is provided and how this influences clinical treatment is discussed.
Adaptation, Physiological↗
The application of force to the healing tendon.
This paper redefines the term "active motion" in postoperative tendon management programs as "minimal active muscle-tendon tension" (MAMTT), and reports a study of internal forces applied to a repaired tendon with MAMTT, with specific guidelines for joint angle and external load application, that allows a repeatable and reliable technique for the application of active stress to a healing tendon repaired with some currently available popular suture techniques. A comparative analysis of the reported tensile strengths of 28 different repair techniques comparing methods of study with conversion of newtons to grams provides the therapist easy access to a workable equation for force application being less than the tensile strength of any specific repair. The "active" hold position or MAMTT for the digital flexor system is calculated mathematically, with drag eliminated, and joint angle position of 45 degrees wrist extension, metacarpophalangeal joint flexion of 83 degrees, proximal interphalangeal joint flexion of 75 degrees, and distal interphalangeal joint flexion of 40 degrees, and an external load applied at the fingertip of 50 grams. In this position, the internal force on the flexor digitorum profundus is 41 grams, and that on the flexor digitorum superficialis is 605 grams. These forces dramatically increase as joint angles become greater, creating forces that exceed the tensile strengths of most repairs. Internal forces along the extensor system are calculated mathematically at approximately 300 grams when the wrist is positioned at 20 degrees of flexion, and the digital joints at a position of 0 degrees of extension in an active hold position. Postoperative management of the repaired flexor or extensor tendon with immediate active motion described as MAMTT is supported by a clinical review of 165 tendons treated with this technique.
Adult↗
Natural history of os odontoideum.
Os odontoideum has recently been considered an acquired lesion of the second cervical vertebrae. This case documents the natural progression of the formation of os odontoideum and correlates it with a traumatic event. This is the first case reported in the literature.
Atlanto-Axial Joint↗
Performance appraisal: the legal implications of Title VII.
Since the enactment of the Civil Rights Act of 1964 and specifically Title VII of the Act, the federal government has increasingly involved itself with personnel policies and practices of employers in both the public and the private sector. While Title VII was initially directed toward discriminatory employee selection practices, the development of case law in this area suggests that the courts are now interpreting the Act much more broadly. In light of this, human resources managers would be wise to reevaluate the adequacy of existing performance appraisal systems to make them defensible against charges of discriminatory employment practices. After examining significant cases brought before the courts involving performance appraisal systems, authors Gary L. Lubben, Duane E. Thompson, and Charles R. Klasson draw conclusions as to what would constitute a defensible appraisal system. Chief among these is to make the overall appraisal process as formal, standard, and objective as possible and to consider subjective supervisory ratings as only one component of the overall evaluation process.
Civil Rights↗
Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial.
BACKGROUND: The efficacy of antiresorptive therapy in preventing fractures in women at highest fracture risk, such as very elderly women or those with severe osteoporosis, is uncertain. PARTICIPANTS AND METHODS: Using data from a double-blind, randomized, placebo-controlled clinical trial that enrolled 2027 postmenopausal women aged 55 to 81 years with low femoral neck bone mineral density (BMD) and existing vertebral fractures, we examined the consistency of the effect of treatment with alendronate sodium in preventing fractures within a priori-specified risk subgroups defined at baseline by age, bone density, number of preexisting vertebral fractures, and history of postmenopausal fracture. The women were randomized to oral administration of alendronate or placebo and followed up for an average of 2.9 years. The initial dose of alendronate sodium was 5 mg/d; the dosage was increased from 5 to 10 mg/d at 24 months. New vertebral fractures, the primary end point of this arm of the trial, were defined by morphometry as a decrease of 20% and at least 4 mm in any vertebral height between baseline and a follow-up radiograph at 36 months. Incident clinical fractures, the secondary end point, included nonspine and clinical (symptomatic) vertebral fractures. All clinical fractures were confirmed with x-ray film reports or, in the case of clinical vertebral fractures, x-ray films. RESULTS: Overall, there was a 47% significant reduction in risk of new vertebral fractures in the alendronate group compared with the placebo group. The reduction in risk of new vertebral fracture was consistent across fracture risk categories including age (relative risk [RR], 0.49 in women < 75 years compared with 0.62 in those > or = 75 years), BMD (RR, 0.54 in women with a femoral neck BMD < 0.59 g/cm2 [median] compared with 0.53 in those with a BMD > or = 0.59 g/cm2), and number of preexisting vertebral fractures (RR, 0.58 in women with 1 vertebral fracture compared with 0.52 in those with > or = 2). The overall significant 28% reduction in risk of incident clinical fractures in the alendronate group compared with the placebo group was also observed within these subgroups. Compared with the number of lower-risk women, a similar or smaller number of high-risk women needed to be treated to prevent 1 fracture. For example, 8 women aged 75 years or older compared with 9 women younger than 75 years, or 4 women with 2 or more existing vertebral fractures compared with 16 women with 1 existing vertebral fracture, needed to be treated with alendronate for 5 years to prevent 1 new vertebral fracture. CONCLUSIONS: Alendronate effectively reduces fracture risk in postmenopausal women with vertebral fractures and low BMD, including those women at highest risk because of advanced age or severe osteoporosis. Since the risk reductions observed with alendronate treatment were consistent within fracture risk categories, more fractures were prevented by treating women at highest risk.
Administration, Oral↗