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Biomedical subjects

D Epstein

Publications and source records attributed to D Epstein.

At least 19 recordsLinked to original sources
PubMed1992

Decreased serum bicarbonate as a manifestation of undernutrition secondary to nonorganic failure-to-thrive.

Eight of 101 children (8%) seen serially in consultation in an outpatient failure-to-thrive (FTT) clinic had isolated serum bicarbonate (TCO2) levels between 16 and 20 MEQ/dL (normal 22 to 30 MEQ/dL). None of these eight patients had signs or symptoms of renal disease, and all had nonorganic etiologic factors associated with their malnutrition. At the time of this review, follow-up TCO2 measurements were available for seven of the eight children who had attained normal weight (wt/age greater than fifth percentile on National Center for Health Statistics (NCHS) growth chart). All these children had normal TCO2 levels and no evidence of renal disease on follow-up more than 12 months later. Clinicians treating undernourished children who have low TCO2 measurements and have no signs or symptoms of renal disease and identified nonorganic factors, should consider a trial of therapies directed at nonorganic factors. Clinicians should be aware that a high percentage of undernourished children without other medical disease may have abnormal TCO2 measurements that correct after the institution of adequate caloric intake.

Acidosis, Renal Tubular↗
PubMed1991

The effect of a multidisciplinary team approach on weight gain in nonorganic failure-to-thrive children.

Failure-to-thrive (FTT) is a chronic symptom accounting for 1% of all patients admitted to pediatric hospitals. FTT, which is traditionally attributed to organic (OFTT) and/or nonorganic (NFTT) causes, results in undernutrition. Undernutrition has potentially serious effects on child development, behavior, and cognitive skills. We undertook a study of children with FTT to determine whether multidisciplinary team treatment resulted in improved weight gain compared with children treated in a primary care setting. Fifty-three children with NFTT referred to our outpatient FTT consultative clinic and 107 children with NFTT identified as comparison subjects from our primary care clinic (PCC) were enrolled in the study. Growth outcomes over a 6-month follow-up were analyzed using growth quotient (GQ) analysis. Children followed in the multidisciplinary team clinic grew better (GQ = 1.75 +/- 0.39 SD) than did children in the PCC (GQ = 1.18 +/- 0.42 SD, p less than .001). The use of a multidisciplinary team offers special advantages in the rapid correction of undernutrition in children with NFTT.

Child, Preschool↗
PubMed1990

Pregnancy outcomes in women potentially exposed to solvent-contaminated drinking water in San Jose, California.

During 1980-1981, solvents leaked from an underground storage tank of a semiconductor firm in southern Santa Clara County, California, contaminating local drinking water. The contaminated well was closed in December 1981. An epidemiologic study conducted in 1983 confirmed statistically significant excesses of adverse pregnancy outcomes in an exposed community compared with an unexposed community, but could not establish a causal connection between the leak and the adverse outcomes. This study expanded the first study; adverse pregnancy outcomes occurring in 1980-1985 were studied in two communities exposed to the contaminated drinking water and in two demographically comparable but unexposed communities. The period 1980-1981 was the time period in which the well was considered to have been contaminated and 1982-1985 was considered the postcontamination time period. Both exposed and unexposed communities were considered unexposed during the latter period (1982-1985). Out of 10,055 households surveyed, interviews were conducted with 1,105 women who reported one or more eligible pregnancies. Miscarriages and birth defects were validated by medical record review or physician reports. Although the authors again observed statistically significant excesses of spontaneous abortions and birth defects in the originally studied exposed area in 1980-1981, they observed deficits of these outcomes in the second exposed study area. Adjustment for potential confounders did not alter these findings. Analyses of pregnancy outcomes during 1981 in relation to exposure estimates based on hydrogeologic modeling of water and contaminant distribution within the exposed areas also indicated that the leak was not likely to have caused the observed excesses of adverse pregnancy outcomes in the originally studied area.

Abnormalities, Drug-Induced↗
PubMed1990

[Contact lenses for correction of refractive errors. A status determination].

The contact lens is still the most frequently used visual aid applied directly to the eye to correct refractive errors. The most important refractive indications and the advantages and drawbacks of the major lens types are discussed. Toric, bifocal and disposable lenses are also presented. The development of new, highly gas-permeable rigid materials are considered.

Contact Lenses↗
PubMed1990

[Contact lenses and their problems].

Contact lenses cause many changes in the anterior segment of the eye, mainly in the cornea. The long-term effects on the corneal epithelium, stroma and endothelium are discussed, as are the more acute complications commonly seen in patients. Future trends in the contact lens field are also dealt with briefly.

Contact Lenses↗
PubMed1989

Procainamide N-acetyltransferase: modulation by clofibrate and a microsomal form.

1. Detoxification of procainamide by N-acetyltransferase which occurs primarily in the cytoplasmic fraction of the rat liver can be modulated by clofibrate treatment. 2. When the concentration of one of the substrates, procainamide, is 100 microM while the other, acetyl CoA, is 10 or 100 microM, the specific activity is reduced following clofibrate treatment. However, total activity is unchanged because of a 44% increase in cytoplasmic protein. 3. At more physiological levels of the two substrates (10 microM), total enzyme activity is increased from 9.5 +/- 1.5 to 14.0 +/- 1.8 pmol/mg/min, P less than 0.05. 4. A microsomal form of N-acetyltransferase activity is reported which is unaffected by the concentration of acetyl CoA in contrast to the cytoplasmic form.

Acecainide↗
PubMed1989

Outflow resistance of enucleated human eyes at two different perfusion pressures and different extents of trabeculotomy.

Aqueous outflow resistance of enucleated human eyes was measured at 7 and 25 mm Hg before and after partial and complete (12 clock hours) internal trabeculotomy. Following complete trabeculotomy, 71% of the resistance was eliminated at 25 mm Hg while only 49% was eliminated at 7 mm Hg. In contrast to published findings in eyes with intact trabecular meshwork where the resistance increased with increasing IOP (1), following complete trabeculotomy, the resistance decreased 2% per mm Hg with increasing IOP. Experiments with trabeculotomy limited to part of the circumference showed that a one hour trabeculotomy produced 41% (25 mm Hg) to 60% (7 mm Hg) of the effect of a twelve hour trabeculotomy. The results indicate that a surprisingly high fraction of aqueous outflow resistance resides in the distal aspects of the outflow system at normal IOP, and that this distal resistance drops as IOP is increased.

Aged↗
PubMed1989

Efficacy of a suicide detection scale in determining lethality of ideation among hospitalized veterans: a case study.

Active suicidal ideation, its underlying psychopathology, concomitant stressors, and ultimate self-destructive behaviors can compromise the combat readiness of the military. An investigation into the clinical utility of a pre-suicidal detection scale (Suicide Probability Scale (SPS] was recently undertaken at the Veterans Administration Medical Center, Hampton, Virginia. A record review of 1,397 patients who were administered the SPS was conducted. Data indicate that 100% of a sample of patients were accurately identified as either imminently or chronically suicidal. The incidence of false negatives was 50%. Results suggest that while the SPS appears to accurately identify patients who have potentially dangerous levels of suicidal ideation, it does not adequately determine lethality or chronicity of suicidal ideation without intent. Potential uses of the SPS are discussed, military health care environments in which its use may be warranted are considered, and future directions are examined.

Hospitalization↗
PubMed1987

Latent growth curves within developmental structural equation models.

This report uses structural equation modeling to combine traditional ideas from repeated-measures ANOVA with some traditional ideas from longitudinal factor analysis. A longitudinal model that includes correlations, variances, and means is described as a latent growth curve model (LGM). When merged with repeated-measures data, this technique permits the estimation of parameters representing both individual and group dynamics. The statistical basis of this model allows hypothesis testing of various developmental ideas, including models of alternative dynamic functions and models of the sources of individual differences in these functions. Aspects of these latent growth models are illustrated with a set of longitudinal WISC data from young children and by using the LISREL V computer program.

Child↗
PubMed1986

Low-luminance myopia and dark vergence.

In normal binocular vision, under photopic conditions, accommodation and convergence act in synergy. We examined the relationship between these two functions in darkness, in the absence of all accommodative and fusional stimuli. Accommodation was measured as it is expressed in low-luminance myopia. There was no strong positive correlation between accommodation and vergence in darkness. Rather, the two systems were dissociated, and appeared to assume independent resting states with accommodation generally exceeding convergence.

Accommodation, Ocular↗
PubMed1985

[Effect of a decade of wearing contact lenses on the physiology and morphology of the eye].

A retrospective study of 230 HEMA eyes and 210 PMMA eyes with a history of regular contact lens wear (no extended wear) for 10 or more years was carried out on subjects with initially normal eyes. One hundred percent of the eyes showed pathologic changes although some of the pathology was of a minor nature. Irregular astigmatism was found in the majority of the PMMA eyes and 44.3% of the HEMA eyes. Pathologic corneal vascularization (greater than 1.5 mm) was found in over 40% of both groups; the HEMA lenses generally caused more and deeper vascularization. These and other observations indicate that when contact lenses, are worn for a decade or longer they may well influence the eye to a greater extent than is widely assumed.

Adult↗
PubMed1982

Nonphysician health care providers in pediatrics.

This paper has identified nurse practitioners, physician's assistants and, potentially, nurse-midwives, as nonphysician health care providers who might have a significant impact on physician manpower requirements in pediatrics in the United States. These providers are capable of providing well child care, as well as care for minor illnesses. Patient acceptance and the quality of care rendered by these providers appear to be high. Physician acceptance is also high, especially when the physician has actually employed a nonphysician provider. State legislation and reimbursement procedures may interfere with the full utilization of nonphysician providers, but when nurse practitioners and physician assistants are employed in pediatric care, they deliver a wide range of services efficiently and economically. There are estimated to be a total of approximately 5,500 nonphysician providers specializing in pediatric care, but other nonphysician providers who may also care for children are discussed. The total number of these providers for 1980 is estimated at 7,232 and for 1990, at 15,512.

Clinical Competence↗