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Biomedical subjects

D R Miller

Publications and source records attributed to D R Miller.

At least 415 records · Page 23Linked to original sources
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A new derivation of average molecular weights of nonlinear polymers.

A new method for calculating average molecular weights is presented for nonlinear polymers. In contrast to the previous methods of Flory and Stockmayer which first calculate the distribution of all species and then use the distributions to calculate average properties, the new method calculates these properties directly. In contrast to the method of Gordon, probability generating functions are not required. Starting with elementary probability and utilizing the recursive nature of network polymers property relations can be developed more simply. We illustrate the method for calculations of Mw Mz, and the gel point for a wide variety of polyfunctional polymerizations.

Mathematics↗
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The New Moms Project: educating mothers about sun protection in newborn nurseries.

Sun protection habits should begin early in life and be taught as part of routine preventive health care. Early teaching of parents aims to introduce an easily achieved means of sun protection with the goal of instilling these practices as habits in the parents and their young children. We developed a maternity nurse-led intervention for 187 mothers at newborn nurseries in Falmouth, Massachusetts, combining educational material and personal discussions. One year after the intervention we successfully contacted 73% of the mothers. Nearly 90% recalled the informational program and equal numbers stated that receiving educational materials in the newborn nursery was timely. Nearly two-thirds of mothers reported that this was the only sun protection information received from a provider in the past year.

Data Collection↗
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Serologic evidence of hepatitis A and B virus infections in thalassemia patients: a retrospective study.

To determine the current risk of hepatitis B virus (HBV) infection in multiply transfused thalassemia patients, we tested sera from such patients in New York City for the hepatitis B surface antigen (HBsAg) and its antibody (anti-HBs) using radioimmunoassay techniques. Altogether 48 per cent of the patients had either HBsAg (4.5%) or anti-HBs (43.9%) positive sera. The prevalence of these HBV markers was related to both the number of units transfused and the year blood transfusion therapy was begun, although evidence suggested that the latter factor had the greatest influence. Donor HBsAg screening began in New York in 1969, and only one patient first transfused since that time had HBV marker positive serum. Thus, multiply-transfused thalassemia patients now appear to be at little risk of HBV infection from transfusions. Sera were also tested for antibody to the hepatitis A virus (anti-HA) using immune adherence hemaglutination. Anti-HA prevalence was only 4.9 per cent, no greater than rates reported among nontransfused children, providing evidence against a significant role for blood transfusions in hepatitis A virus transmission.

Adolescent↗
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The role of emergency medical services in primary injury prevention. East Carolina Injury Prevention Program.

Injury is a leading cause of death and disability. Preventing injuries from ever occurring is primary injury prevention (PIP). The objective of this statement is to present the consensus of a 16-member panel of leaders from the out-of-hospital emergency medical services (EMS) community on essential and desirable EMS PIP activities. Essential PIP activities for leaders and decision makers of every EMS system include: protecting individual EMS providers from injury; providing education to EMS providers in PIP fundamentals; supporting and promoting the collection and utilization of injury data; obtaining support for PIP activities; networking with other injury prevention organizations; empowering individual EMS providers to conduct PIP activities; interacting with the media to promote injury prevention; and participating in community injury prevention interventions. Essential PIP knowledge areas for EMS providers include: PIP principles; personal injury prevention and role modeling; safe emergency vehicle operation; injury risk identification; documentation of injury data; and one-on-one safety education.

Community-Institutional Relations↗
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EMS Agenda for the Future: where we are...where we want to be.

During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the course of several months, a multidisciplinary steering committee collaborated with hundreds of EMS-interested individuals, organizations, and agencies to develop the EMS Agenda for the Future. Fourteen EMS attributes were identified as requiring continued development in order to realize the vision established within the Agenda. They are integration of health services, EMS research, legislation and regulation, system finance, human resources, medical direction, education systems, public education, prevention, public access, communication systems, clinical care, information systems, and evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care.

Delivery of Health Care, Integrated↗
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Effect of selenium on distribution, demethylation, and excretion of methylmercury by the guinea pig.

The influence of selenium on methylmercury excretion, organ and subcellular distribution, and demethylation was studied in the guinea pig at different times following a single equimolar dose (50 miroM/kg) of CH203 3) HgCl and Na2SeO3 administered separately or concomitantly per os. Excretion of mercury through feces was the dominant clearance pathway in both groups. Selenium significantly decreased excretion of total and organic mercury in feces during the course of the study, but in the urine only on d 13. Selenium also significantly decreased the concentration of total mercury in major organs. The exception was brain on d 1, in which mercury levels were higher in the presence of selenium; however, on d 7 and 13 both cerebrum and cerebellum showed lower mercury levels as compared to the group treated with methylmercury alone. Selenium had no significant effect on the subcellular mercury distribution in the liver, kidney, and cerebrum, other than that which could be accounted for the whole organ uptake. The level of organic mercury in most of the analyzed organs was significantly decreased by the presence of selenium; however, relative proportions of inorganic to organic mercury remain unchanged. The single exception was kidney, where selenium markedly decreased the relative amount of inorganic mercury.

Animals↗
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Medical profile of women Veterans Administration outpatients who report a history of sexual assault occurring while in the military.

To profile differences in current physical symptoms and medical conditions among women users of Veterans Administration (VA) health services with and without a self-reported history of sexual assault sustained during military service, we conducted a cross-sectional analysis of a nationally representative, random sample of women veterans using VA outpatient services (n = 3632). A self-administered, mailed survey asked whether women had sustained sexual assault while in the military and requested information about a spectrum of physical symptoms and medical conditions. A history of sexual assault while in the military was reported by 23% of women VA users and was associated with current physical symptoms and medical conditions in every domain assessed. For example, women who reported sexual assault were more likely to indicate that they had a "heart attack" within the past year, even after adjusting for age, hypertension, diabetes, and smoking history (OR 2.3, 95% CI 1.3-4.0). Among women reporting a history of sexual assault while in the military, 26% endorsed > or = 12 of 24 symptoms/conditions, compared with 11% of women with no reported sexual assault while in the military (p < 0.001). Clinicians need to be attuned to the high frequency of sexual assault occurring while in the military reported by women VA users and its associated array of current physical symptoms and medical conditions. Clinicians should consider screening both younger and older patients for a sexual violence history, especially patients with multiple physical symptoms.

Adult↗
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Health status in VA patients: results from the Veterans Health Study.

Recently, the Veterans Administration (VA) Under Secretary for Health has designated functional status as one of the domains of value for the system, given its increasing importance for clinical care. The Veterans Health Study (VHS) was designed to assist the VA in monitoring outcomes and measuring the case mix of patients who use the VA. The Veterans SF-36 (short form functional status assessment for veterans) was administered to 2425 veterans receiving ambulatory care. Measures of the Veterans SF-36 were strongly correlated with sociodemographics and morbidities of the veterans. Young veterans had poorer mental health status than older veterans. Veterans who used ambulatory care in the VHS reported lower levels of health status, reflecting more disease than a non-VA civilian population. These measures of health are important indicators of the disease burden or case mix of the patients and are pertinent to health systems such as the VA for resource allocation decisions and as outcomes of care.

Adult↗
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Varicella susceptibility and vaccination strategies in young adults.

BACKGROUND: Varicella infection causes substantial morbidity in young adults. Most military basic trainees are 18 to 21 years old, yet the Army has no varicella vaccination policy. We therefore determined varicella susceptibility in a population of Army basic trainees, examined variables that might predict antibody status, and developed a vaccination strategies model. METHODS: Fifteen-hundred ninety-five trainees completed a demographic and historical questionnaire. Varicella antibody status was determined on 1201 volunteers. These data plus information from the literature were used to construct a decision tree of vaccination strategies that was applied to the total population of Army basic trainees in 1995 (n = 65,298). RESULTS: Fifty (4.2 percent) of 1201 soldiers were antibody negative. Trainees who lived with no or 1 sibling while growing up were most likely to be seronegative (P < 0.01). The positive predictive value of a history of varicella was 98.5 percent, whereas the negative predictive value of a negative history of varicella was 23 percent. In the vaccination strategies model, serologically testing soldiers with a negative history of varicella and vaccinating those without protective antibodies was the most cost-effective approach. CONCLUSIONS: In young adults a positive varicella history accurately predicts immunity, but verification of a negative history with antibody testing is recommended before vaccination.

Adolescent↗
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Lens opacities in thalassemia.

This is the first case report of cataracts in patients with thalassemia major. Desferrioxamine, an iron-chelating agent is being used with increasing frequency in the treatment of transfusion-induced iron overload. There has been some concern in the literature about possible cataract formation with use of this drug. It is therefore important to document any lens opacities seen prior to administration of desferrioxamine, or record the appearance of lens opacities after its use. The possible eitology of these lens opacities is discussed.

Adolescent↗
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Collaborative Behavioral Teratology Study: preliminary research.

Prior to the beginning of the Collaborative Behavioral Teratology Study (CBTS), extensive preliminary experiments were conducted. Several experiments were conducted to permit the selection and verification of dosage levels of d-amphetamine sulfate and methylmercuric chloride to be used in the CBTS. These studies included evaluations of any teratogenic effects produced by selected concentrations of the chemicals, the potential pathology produced in the dams and offspring, and the postnatal behavioral consequences of the prenatal exposures. This preliminary research allowed the determination of the most appropriate experimental design for the CBTS, verified the practicality of the schedule of work, assured that all necessary procedural details were specified, and provided a database for the determination of the most appropriate statistical techniques for the analyses of the data. This paper presents the details and results of the preliminary research performed prior to beginning the CBTS.

Animals↗
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Myocardial infarction and cigarette smoking in women younger than 50 years of age.

The modifying influence of individual risk factors on the relation between myocardial infarction (MI) and cigarette smoking was evaluated in a case-control study of women younger than 50 years of age. Data from 555 women who survived first MIs were compared with those of 1,864 hospital controls of similar ages. The risk of MI increased with the number of cigarettes smoked, both in the presence and absence of factors that predispose to an infarction. In particular, the association was apparent at all ages, at all levels of total serum cholesterol and high-density lipoprotein cholesterol, and in the presence and absence of oral contraceptive use, hypertension, diabetes mellitus, blood group A, tendency to type A behavior, and family history of MI. The relative increase in risk was generally greater the lower the underlying predisposition to MI. There was clear evidence, however, that recent oral contraceptive use substantially augmented the increased risk for smokers, and hypercholesterolemia may have had the same effect.

Adult↗
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Large saccular aneurysm and A-V fistula of the brachial vessels.

This paper reports a 39-year-old patient who developed an unusually large saccular false aneurysm and A-V fistula of the brachial vessels following a neglected penetrating wound. Rapid enlargement to 15 cm appeared after one year and the aneurysm was then stable for the six months prior to operative repair. The aneurysm was excised and lateral closure of the vessels restored continuity with uneventful recovery.

Adult↗
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Ultrasonic vocalizations as diagnostic tools in studies of developmental toxicity: an investigation of the effects of prenatal treatment with methylmercuric chloride.

Ultrasonic vocalizations were recorded during two tasks from four groups of neonatal CD rat pups. Groups 0, 2, 4 and 6 were the offspring from pregnant dams treated with 0, 2, 4 or 6 mg/kg methylmercuric chloride by gavage on gestation day 7. On the day of birth, Day 1, litters were randomly culled to 8 pups (4 males, 4 females). The pups were weighed on Days 1, 7, 14, 21 and 30, and no weight differences due to treatment were observed. At 5, 7, 9 and 11 days of age, ultrasonic vocalizations were recorded from the animals for 1 minute. Individual animals were placed in a small test chamber containing either soiled home cage bedding or clean bedding material. Half of the pups in each litter were tested in each "odor" condition, and the rate and duration of the vocalizations were measured for 1 minute. On days 8 and 9, pups were tested on a negative geotaxis incline during which time vocalizations were recorded. In both the "odor" and negative geotaxis tests, methylmercuric chloride affected vocalization rates in a nonlinear dose-response fashion. Regardless of treatment group, the pups vocalized at a higher rate and for a longer duration in the clean than in the soiled bedding test condition. These data showed the variability of the ultrasonic vocalization responses to be smallest for the animals tested at 11 days of age in the clean bedding condition. The results of this study suggest that the value of ultrasonic calls as dependent measures of toxicity may be strengthened by the use of multiple stimulus conditions in order to elicit a graded response pattern. This would facilitate the interpretation of potential nonlinear dose-response effects.

Age Factors↗
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Use of prognostic factors in improving the design and efficiency of clinical trials in childhood leukemia: Children's Cancer Study Group Report.

Prognostic factors are exerting an increasingly apparent and important influence on the results of comparative treatment regimens in childhood leukemia. Since February 1975, 883 previously untreated children with acute lymphocytic leukemia were entered in a protocol designed to evaluate prognostic factors that influence induction rate, remission duration, and survival and to identify subsets of patients with a high risk of early failure. Stratification was based upon the initial wbc count, and standard and more intensive induction and maintenance therapy programs were compared. The combination of older age (> 10 years), high initial wbc counts (greater than or equal to 20 x 10(9)/liter), and low serum IgG is associated with a significantly lower rate of induction of complete remission. The following factors were associated with an unfavorable prognosis with regard to bone marrow relapse and death: wbc count of greater than or equal to 20 x 10(9)/liter; age > 7 years old; CNS disease at diagnosis; L2 lymphoblasts; hemoglobin level greater than or equal to 11 g/dl; decreased concentration of serum immunoglobulin; and M3 marrow on Day 14 of induction. None of the 41 patients in the low-risk prognostic group (3-7 years old with an initial wbc count of < 10 x 10(9)/liter) with L1 blast cells, normal Ig, and M1 marrow on Day 14 has sustained an adverse event. Identification of prognostic factors should permit more efficient and effective design of future protocols by refining the classification of acute lymphocytic leukemia, decreasing the toxic risk to patients with a better prognosis, and improving the relatively poor remission duration and survival for patients with a poor prognosis.

Age Factors↗