Study, endpoints, goals, and prioritization for a program in hazardous chemical epidemiology.
Explore the source record for details and available documents.
Algorithms↗
Biomedical subjects
D Smith
Publications and source records attributed to D Smith.
Morphology and performance of world championship triathletes.
Performance is related to body morphology in many sports. With triathlon making its debut into the Olympic programme in 2000, it was deemed important to determine which physical characteristics of elite-level triathletes were significantly related to performance. Seventy-one elite and junior elite triathletes, from 11 nations, competing at the 1997 World Triathlon Championships were measured on a battery of 28 anthropometric dimensions. A factor analysis was conducted, which reduced the number of variables to four and these were used in a stepwise linear regression to determine which morphological factors were important to performance. Elite triathletes were significantly (p < 0.05) faster than their junior counterparts (males 1:52:26 vs. 2:03:23 and females 2:07:01 vs. 2:14:05) and showed less variation in performance times. Run time variation was the largest of the component disciplines and tended to show the importance of this discipline to the final outcome. Following a factor analysis the four distinguishable morphological factors that emerged were: robustness, adiposity, segmental lengths and skeletal mass. Relating these factors to the total time obtained by the triathletes in this study yielded a regression equation that correlated significantly with all triathletes, accounting for 47% of the variance in total triathlon duration. The regression equations illustrated the importance of low levels of adiposity for elite triathletes for total time and most of the subdisciplines. The other factor that showed importance was that proportionally longer segmental lengths contributed to successful swimming outcome.
Adult↗
Portable biofeedback apparatus for treatment of anal sphincter dystonia in childhood soiling and constipation.
Biofeedback is an effective treatment for anal sphincter dysfunction in many cases of childhood constipation and soiling. Conventional methodologies centre on clinic-based manometric apparatus but are compromised by equipment being thinly available and practice sessions often infrequent. To counter these shortcomings, we have designed a portable anorectal biofeedback apparatus (the Easograph) for domiciliary use. It can be lent to families, enabling carers to mediate what is an intrinsically sensitive procedure. In this paper, we provide a technical description of the device which is based on an inexpensive pressure transducer. Casework experience suggests it is reliable in operation and readily understood by users. In a pilot study of eight patients treated with the apparatus, five achieved bowel continence after lifelong soiling in one to eight weeks of daily practice. We believe this is an innovative approach that has good potential for treating faecal retentive and expulsive disorders in childhood associated with poor anal sphincter control.
Anal Canal↗
Cefoxitin in obstetric and gynecologic infections.
The use of cefoxitin sodium in 178 patients with a wide variety of obstetric and gynecologic infections was studied. Clinical cure occurred in 94% of the study population, and two women with serious underlying medical problems died. These good results with cefoxitin should stimulate prospective studies comparing this drug to currently employed antibiotic regimens.
Cefoxitin↗
The metabolism and elimination of d-tubocurarine-H3.
Explore the source record for details and available documents.
Animals↗
Behavioral management of urinary incontinence in homebound older adults.
Explore the source record for details and available documents.
Aged↗
Diagnosis-related groupings (DRGs) and wound closure: roundtable discussion.
Explore the source record for details and available documents.
Burns↗
Dehydroepiandrosterone fails to improve immunoglobulin synthesis and lymphocyte mitogenic response after burn injury.
Dehydroepiandrosterone has been proposed as a means of restoring immune function after injury. In this study we examined the effect of dehydroepiandrosterone on the impaired immunoglobulin M synthesis and depressed lymphocyte mitogenic responses observed after burn injury. We divided BALB/c mice (n = 28) into four equal groups that received either a 25% total body surface area dorsal steam burn or a sham procedure. One hour later we injected mice subcutaneously either with 100 micrograms dehydroepiandrosterone or vehicle alone. Five days later we isolated splenocytes for assessment of immune function. We stimulated splenocytes with lipopolysaccharide and 5 days later measured immunoglobulin M synthesis specific for peptidoglycan polysaccharide, a ubiquitous bacterial antigen. We stimulated additional cultures with lipopolysaccharide or concanavalin A to measure B- or T-lymphocyte mitogenic response. Burn injury impaired peptidoglycan polysaccharide-specific immunoglobulin M synthesis compared with sham (p < 0.05), and this impairment was not restored by the administration of dehydroepiandrosterone (p < 0.05). Furthermore dehydroepiandrosterone did not correct the burn-induced impairments of B- and T-cell mitogenic responses (p < 0.05). Our study demonstrates that in this model the administration of dehydroepiandrosterone in vivo does not correct the impairments of humoral or cellular immunity induced by burn injury.
Animals↗
Regional and institutional variation in burn care.
In reviewing the literature on burn therapy and observing clinical burn care, we noted differences among institutions and individual experts in several areas. To study variation in burn care, we surveyed the 140 burn centers listed by the American Burn Association to determine how burn care is currently administered in the United States and Canada. Responses were obtained from 83 hospitals (60%). The survey addressed resuscitation, operative and nonoperative wound care, medications, antimicrobial agents, and pain control. The major influence on care appeared to be the experience of the director (considered "very influential" in 85%) compared with the literature ("very influential" in 12%) and habit/what works for us ("very influential" in 48%). The Parkland formula was used "always" or "often" by 78%, and the Brooke formula "never" by 81% of respondents. Lactated Ringer's solution was the most popular initial fluid, and most (78%) respondents changed fluids after 24 hours. However, the fluids used in the second 24 hours varied equally among several choices. The use of colloids also varied without a set pattern. Furosemide (Lasix) and nonsteroidal antiinflammatory drugs were used "rarely" or "never" by 67% of centers in the acute stage. H2 blockers were used for gastritis prophylaxis "always" or "often" in 60% (vs 53% for antacids and 20% for sucralfate [Carafate]). Tube feedings were started on day 1 after burn injury "always" by less than 30% of centers. Total parenteral nutrition was not commonly used. Most centers use of silver sulfadiazine on the body and hands, but facial topical antimicrobial therapy varied.(ABSTRACT TRUNCATED AT 250 WORDS)
Anti-Bacterial Agents↗
MR cholangiography in biliary obstruction using half-Fourier acquisition.
PURPOSE: Our goal was to evaluate biliary obstruction using a T2-weighted, turbo, SE MR sequence with half-Fourier acquisition (HASTE). METHOD: A prospective evaluation of 21 consecutive patients with clinical evidence of obstructive jaundice was carried out comparing HASTE MR cholangiography (MRC) to endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography. A control group of five normal volunteers was also evaluated. The study group was imaged with a 1.5 T MR scanner using a body coil. The HASTE sequence was applied in axial, coronal, and oblique sagittal planes. Ultrafast acquisition scanning times allowed the use of a single breath hold. Bile duct dilatation, level of obstruction, and cause of obstruction were assessed on both imaging modalities by two radiologists blinded to the clinical diagnosis and to each other's results. RESULTS: All studies were interpretable with anatomy well seen in 82% of the cases. MRCs of a normal control group were correctly interpreted. The presence of biliary dilatation was accurately depicted by HASTE MRC in 100% of patients with complete interobserver agreement. The level of obstruction was depicted correctly in 87% of patients with 93% interobserver agreement. The right main duct was seen by MRC in 80% of obstructed systems. The left main duct was seen in all obstructed patients. The gallbladder was identified in 88% of patients by MRC. Common bile duct stricture and stones could be differentiated as a cause of obstruction in all cases. CONCLUSION: MRC using the HASTE imaging sequence can safely and accurately depict the presence and level of biliary obstruction. The fast acquisition time of 13 s/scan makes the technique suitable for uncooperative and ill patients. HASTE MRC should be considered an alternative procedure to direct cholangiography in selected patients.
Aged↗
Organizational theory and the hospital.
Explore the source record for details and available documents.
Interpersonal Relations↗
Characterization of mutations in 22 females with X-linked dominant chondrodysplasia punctata (Happle syndrome).
PURPOSE: Human X-linked dominant chondrodysplasia punctata (CDPX2) or Happle syndrome is associated with mutations in the human emopamil binding protein (EBP), a delta8-delta7-sterol isomerase involved in cholesterol biosynthesis. The purpose of the current study was to determine the spectrum of EBP mutations in females with CDPX2 and the utility of biochemical screening for the disorder by analysis of plasma sterols. METHODS: Genomic sequencing of the coding exons of the human delta8-delta7-sterol isomerase gene was performed on DNA from 26 females with suspected X-linked dominant chondrodysplasia punctata. Clinical data and sterol analyses were obtained for 24 and 23 of the patients, respectively. RESULTS: Mutations in the human EBP delta8-delta7-sterol isomerase gene were found in 22 (85%) of 26 females studied, including 20 (91%) of 22 patients who demonstrated an abnormal sterol profile. Thirteen of the mutations have not been reported previously. All of the females in whom mutations were found demonstrated typical skin manifestations of CDPX2, and all but one had a skeletal dysplasia. CONCLUSIONS: Plasma sterol analysis was a highly specific and sensitive indicator of the presence of an EBP mutation in females with suspected CDPX2, including a clinically unaffected mother of a sporadic case. No clear genotype/phenotype correlations were ascertained, probably because phenotypic expression is influenced substantially by the pattern of X-inactivation in an affected female.
Chondrodysplasia Punctata↗
Is atherosclerosis exclusively a postprandial phenomenon?
1. Atherosclerosis begins with the deposition of cholesterol in arterial tissue that is thought to be derived from circulating lipoproteins. There is considerable evidence implicating low density lipoprotein (LDL) as a primary source of plaque cholesterol and, consequently, there are many articles that deal with various aspects of LDL metabolism. 2. Postprandial lipoproteins (i.e. chylomicrons transporting dietary fats) are also considered pro-atherogenic; however, it is less clear whether their involvement in arterial cholesterol deposition is direct or follows modulation of LDL metabolism. 3. In order to provoke discussion, this article is presented in a manner that suggests atherosclerosis to be exclusively a postprandial phenomenon; that is, we have raised the possibility that LDL is non-atherogenic.
Animals↗
Outcomes of add-on treatment with lamotrigine in partial epilepsy.
The need for new antiepileptic drugs (AEDs) and more sensitive methods of assessing their efficacy is well recognized. This study was designed to evaluate the efficacy and safety of lamotrigine (LTG), a potential new AED and to develop and test new outcome measures. A health-related quality of life (HRQL) model was developed which contains previously validated measures of anxiety, depression, happiness, overall mood, self-esteem, and mastery and a specifically designed seizure severity scale with patient- and caregiver-based components. This HRQL model was used in a randomized, placebo-controlled, double-blind, cross-over study of LTG in 81 patients with refractory partial seizures. Seizure frequency was the primary measure and seizure severity and the HRQL were secondary measures of efficacy. The reduction in seizure frequency with LTG, relative to placebo, was 29.7% [95% confidence interval (CI) 17.8%, 39.9%] for total seizure count, 33.4% (95% CI 14.8%, 47.9%) for complex partial seizures (CPS) and 20.3% (95% CI 0.3%, 36.2%) for secondarily generalized tonic-clonic seizures (GTCS). However, although 41 patients elected to continue with LTG, only 11 experienced at least 50% reduction in total seizures, indicating that other factors influenced their decision. The score with LTG, relative to placebo, was significantly lower for the ictal (p = 0.017) and caregivers (p = 0.035) subscales of the seizure severity scale and significantly higher for happiness (p = 0.003) and mastery (p = 0.003). Simple correlation and multiple-regression analyses indicate that the effects on seizure frequency, seizure severity, and psychological variables appear to be independent of each other. This study indicates that LTG is effective in reducing seizure frequency and has additional favorable effects on seizure severity, mood, and perceived internal control. Some of the scales used indicate the potential of secondary measures of efficacy to enhance the sensitivity of trials of new AEDs.
Adolescent↗
Toward improvements in parenting: a description of prenatal and postpartum classes with teaching guide.
A pilot program was developed at an urban community hospital in an attempt to enhance the educational preparation of new and expectant parents and to provide them with the opportunity to examine their values and expectations relating to parenthood. Forty-one couples attended prenatal and postpartum classes. Child development and parenting issues were the main topics of discussion. The effectiveness of the educational program and instructor performance were evaluated through questionnaires measuring parenting knowledge and emotional support. Also, a teaching guide was developed and published.
Curriculum↗
Gastrointestinal studies in the green iguana: technique and reference values.
Five healthy green iguana (Iguana iguana) were used to determine appropriate technique and normal transit times for gastrointestinal contrast studies and to describe normal radiographic anatomy. The animals were maintained at 27-29 degrees C. There was rapid transit through a U shaped stomach, with a median gastric emptying time of 8 h, and median small intestinal transit and small intestine emptying times of 4 h and 16 h respectively. Median large colon transit and emptying times were 15 h and 66 h. Maintaining the iguana at a reduced ambient temperature increased all of these times. The vaso-vagal response or mechanical methods were adequate for restraint. A 25 ml/kg dose of a 25% w/v suspension of barium administered by stomach tube gave the best results. Lateral and ventrodorsal projections of the abdomen should be made immediately following the administration of the barium and at 1-hour intervals for the first 6 h and at 12-hour intervals thereafter until barium can be identified in the distal descending small colon.
Animals↗
Integrating nursing diagnoses, interventions, and outcomes in public health nursing practice.
TOPIC: Applying standardized nursing language in public health nursing practice. PURPOSE: To develop a charting format to document public health nursing practice based on standardized nursing language. SOURCES: Literature review of documentation systems for public health nursing practice. CONCLUSIONS: A task force of public health nurses developed a charting format based on Taxonomy I of Nursing Diagnosis (NANDA), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC).
Forms and Records Control↗
Mediastinal large cell lymphoma: prognostic significance of CT findings at presentation and after treatment.
OBJECTIVE: Primary mediastinal large cell lymphoma is a distinctive subtype of non-Hodgkin's lymphoma. Computed tomography (CT) has become an integral part of the evaluation of these patients at presentation and after completion of therapy. The purpose of this study is to identify CT features that predict increased risk of relapse. METHODS: A retrospective study of patients with primary mediastinal large cell lymphoma who underwent CT scans of the thorax. RESULTS: Tumor volume greater than 100 ml after completion of therapy was a statistically significant predictor of increased risk of relapse (p=0.02, Fisher exact test). Other measurements (obtained at presentation and after completion of treatment) were not statistically significant in predicting relapse. CONCLUSION: CT plays an important role in predicting outcome in primary mediastinal large cell lymphoma. Large residual tumor volume after completion of treatment predicts an increased risk of relapse.
Adult↗