Computerized care planning.
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Academic Medical Centers↗
Biomedical subjects
E Miller
Publications and source records attributed to E Miller.
Treatment of cadaveric renal transplant recipients with total lymphoid irradiation, antithymocyte globulin, and low-dose prednisone.
The ability of preoperative total lymphoid irradiation (TLI) to reduce the need for chronic immunosuppression after cadaveric renal transplantation was examined in 25 recipients who were given a brief course of antithymocyte globulin (ATG) postoperatively with daily low-dose prednisone (0.1-0.2 mg/kg) as the sole maintenance immunosuppressive drug. Patients were selected for the study on the basis of their low levels of cytotoxic antibodies. Grafts were not HLA-matched, and the mean interval between completion of TLI and transplantation was 9 days. During an observation period of up to 25 months, 2 grafts were lost because of rejection. There were two deaths due to disseminated viral infections and two to late cardiovascular complications. At the last observation point, the mean serum creatinine of the 19 patients with functioning grafts was 1.5 mg/dl, and the mean dose of prednisone was 10.2 mg/day. 10 of these patients did not have a rejection episode. Comparison of patients given TLI with a group given cyclosporin at the same institution showed similar graft survival but better graft function in the TLI group.
Adult↗
Effect of selective vaccination on rubella susceptibility and infection in pregnancy.
The effect of school and adult vaccination on susceptibility to rubella in women of childbearing age was assessed in the Manchester area, where the population attending antenatal clinics is over 40 000 a year. Between 1979 and 1984 the proportion susceptible fell from 6.4% to 2.7%. In 1984, 4.2% of nulliparous women were susceptible compared with 1.4% of women in their second or subsequent pregnancy. Eighty five per cent of pregnant women screened and found to be non-immune were vaccinated post partum before leaving hospital. Requests for prevaccination screening of non-pregnant women increased in response to a national campaign and at the time of local outbreaks of rubella but only two thirds of those found to be nonimmune were subsequently vaccinated. During 1983 and 1984 infection was confirmed in 57 pregnant women--2% of those non-immune. Selective vaccination has reduced susceptibility to rubella in the childbearing population, but it is suggested that mass vaccination of children of both sexes should be added to the existing policy to control circulation of wild rubella virus and reduce the risk of infection to pregnant women who remain susceptible.
Adolescent↗
Rubella vaccination in the UK: time for a complete strategy.
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Adult↗
Survival strategies for community mental health organizations: a conceptual framework.
Changing conditions call for each Community Mental Health Center (CMHC) to develop a survival strategy based on its own standards and values. The strategy must contain political, funding, programmatic, structural and role change components. A CMHC must orchestrate its strategy as part of an overall survival plan, but may be constrained by the degree of control it has over programs and resources. Major types of risks associated with entrepreneurial (viz., high control over programs and resources) and restricted models (viz., low control over programs and resources) are reviewed.
Capital Financing↗
The effects of glucose and amino acids on tumor and host DNA synthesis.
Tumor-bearing animals provided with intravenous glucose and amino acids (TPN) exhibit enhanced response to S-phase-specific chemotherapeutic agents (H. M. Reynolds, J. M. Daly, B. Rowlands, S. J. Dudrick, and E. M. Copeland. Cancer 45: 3069, 1980; M. H. Torosian, J. L. Mullen, E. E. Miller, et al. J. Parenter. Enteral Nutr. 7: 337, 1983). To determine the mechanism of this response, DNA synthesis rate during starvation or a 48-hr infusion of glucose/amino acids (Glu/AA) was evaluated in tumor, liver, and terminal ileal cells of 68 rats. Tumor cells exhibited a rapid increase in DNA synthesis following the initiation of an infusion of Glu/AA. This increase was most marked after 2 hr of infusion and returned to control levels within 24 hr. Liver DNA synthesis rate increased in both starved and Glu/AA animals over 48 hr with a larger increase in animals receiving Glu/AA. Ileal DNA synthesis decreased equally in both groups. Short pulse Glu/AA produced transient increases in tumor DNA synthesis. Changes in host tissues occurred but followed a different temporal sequence. This may indicate the existence of a period of time following initiation of metabolic manipulation when tumor susceptibility to phase-specific chemotherapeutic agents will be enhanced while host tissues will be spared from increased toxicity.
Adenocarcinoma↗
Maternal-foetal distribution studies in late pregnancy. I. Distribution of [N-methyl-14C]betaine in tissues of beagle dogs and miniature pigs.
[N-Me-14C]Betaine was administered iv as a single dose (5 mg/kg) to pregnant beagle dogs and miniature pigs late in gestation. Two hr after administration of the radiolabel, when the compound was in equilibrium, the dams were killed and the foetuses were removed for determination of the radioactivity in maternal and foetal tissues. Eight litters of dogs (56 foetuses) and four litters of pigs (30 foetuses) were examined. The distribution of betaine in both species showed distinct differences between maternal and foetal tissues, indicating definite placental barriers; the placental distribution factor was estimated to be 52.3% in dogs and 97.8% in pigs. The blood/brain distribution factor was 84.6% in maternal dogs, 89% in maternal pigs, 65.7% in foetal dogs and 0% in foetal pigs. In the dog, maternal liver was the largest depot of the administered betaine, followed by foetal liver. Foetal heart, lung and kidney tissues also incorporated radiolabelled betaine. The highest concentrations of betaine in the pig were found in maternal kidney and liver.
Animals↗
Maternal-foetal distribution studies in late pregnancy. II. Distribution of [1-14C]acrylamide in tissues of beagle dogs and miniature pigs.
[carbonyl-14C]Acrylamide was administered iv as a single dose (5 mg/kg) to pregnant beagle dogs and miniature pigs late in gestation. After a 2-hr equilibration period, the animals were killed and foetuses were removed for determination of the amount of radioactivity in maternal and foetal tissues. In total, six dog litters (33 foetuses) and seven pig litters (45 foetuses) were examined. In dogs, acrylamide was distributed readily to both maternal and foetal tissues with a placental distribution factor of 17.7%. The blood/brain distribution factor was insignificant (5.9%) in maternal dogs and 0% in the foetuses. Maternal liver was the largest depot of the administered acrylamide in the dog, followed by the maternal kidney. In pigs, the placental distribution factor was 31%, and the blood/brain distribution factor was insignificant in both maternal and foetal pigs. Liver and kidney of maternal pigs also contained the greatest amount of radioactivity. Although there appears to be some placental protection of the foetuses from the xenobiotic in the maternal circulation, foetal brain would be exposed to the effect of any acrylamide present in the foetal circulation, since the foetuses of both species had blood/brain distribution factors that were either small or zero, reflecting the absence of a blood-brain barrier.
Acrylamide↗
Possible frontal impairments in Parkinson's disease: a test using a measure of verbal fluency.
It has been suggested that patients with Parkinson's disease might show the same kinds of behavioural impairments as those exhibited by subjects with frontal lesions. Previous tests of this hypothesis have given, at best, equivocal results. Verbal fluency is a measure sensitive to frontal lesions, and data are presented showing that Parkinsonian subjects produce fluency scores similar to those of normal controls and not at all like subjects with left or right frontal lesions.
Brain Damage, Chronic↗
Hypertension prevalence among Penobscot Indians of Indian Island, Maine.
Prevalence of hypertension, measured on a random sample of Penobscot Indian adults on reservation in Maine, was 23 per cent. Only 50 per cent of the hypertensive Penobscots were aware of their condition. Among those treated with antihypertensive medications, 56 per cent were controlled. When compared to a statewide sample of Maine adults, the prevalence of hypertension among Penobscots was similar but awareness was significantly lower.
Adolescent↗
Hypertensive patients.... Anesthetic care techniques emphasized.
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Anesthesia↗
Post-vaccination symptoms following DTP and DT vaccination.
Post-vaccination symptoms in 6,004 infants given adsorbed Diphtheria Tetanus and Pertussis (DTP) vaccine and 4,024 infants given adsorbed Diphtheria and Tetanus (DT) vaccine have been compared. Although crying, screaming and fever were slightly more frequent after adsorbed DTP than adsorbed DT, attacks of high-pitched screaming, episodes of pallor and hypotonia, convulsions, other neurological disorders and sudden infant death occurred with similar frequency in the two groups. No specific neurological effect attributable to the pertussis component was found.
Brain Diseases↗
A comparative trial of the clinical efficacy and pharmacokinetics of 12-hour and 24-hour controlled release theophylline preparations in patients with chronic asthma.
A double-blind crossover comparison of a 12-hour theophylline preparation (Theo-Dur) and a 24-hour theophylline preparation (Theo-24) was conducted with 20 young adult chronic asthmatic patients requiring daily bronchodilator therapy. The study group included 11 males and nine females ranging in age from 12 to 28 years. Clinical status and serum theophylline levels were monitored during the 4-week dosing interval on each medication. On the last day of each test period subjects were monitored closely throughout a 24-hour period. The results indicated little clinical difference between the two medications although there were statistically significant differences in the pharmacokinetic behavior between the two theophylline preparations.
Adolescent↗
Symptoms after primary immunisation with DTP and with DT vaccine.
Symptoms after routine primary immunisation of 6004 infants with diphtheria/tetanus/pertussis (DTP) vaccine and 4024 infants with diphtheria/tetanus (DT) vaccine have been compared. After each dose, crying, screaming, and feverishness were more frequent with adsorbed DTP than adsorbed DT, but the difference was small. Attacks of high-pitched screaming, episodes of pallor or cyanosis with limpness, convulsions, and local reactions occurred with similar frequency after both vaccines. There was a considerable increase in local reactions after the 3rd dose with both vaccines. Over 1000 doses of plain DTP (with no aluminium hydroxide adjuvant) were given during the study. Post-vaccination symptoms were more common after the plain than after the 2 adsorbed preparations.
Crying↗
Basal ganglia lesions and psychological analyses of the control of voluntary movement.
Psychological accounts of the voluntary control of movement recognize the contribution of perceptual and decision processes as well as processes such as motor memory and timing that are more obviously a part of motor control. A model including these and other components is outlined in relation to tracking, a task that has often been used to study human perceptual-motor performance. The need for experimental control in addressing such multi-process models is emphasized. A number of studies of perceptual-motor performance deficits in patients with Parkinson's disease are reviewed. The methods by which the studies relate the behavioural data to the hypothesized underlying processes may be broadly grouped according to whether they use a subtractive logic or take a decompositional approach. These studies suggest that the basal ganglia play a role in the activation of pre-planned movement.
Basal Ganglia Diseases↗
Verbal fluency as a function of a measure of verbal intelligence and in relation to different types of cerebral pathology.
A measure of verbal fluency was derived from groups of patients with focal lesions and dementia and from normal control subjects. A regression equation was also derived to predict fluency from an index of verbal intelligence. Subjects with right or left frontal lesions and those with dementia had depressed fluency scores. When verbal intelligence was taken into account using the regression equation, fluency still remained depressed in subjects with frontal lesions, but for dements the obtained fluency score was similar to that predicted from the measure of verbal intelligence. The results suggest that impaired fluency is a specific phenomenon following frontal lesions but is merely a consequence of intellectual deterioration in dementia.
Alzheimer Disease↗
Severity of whooping cough in England before and after the decline in pertussis immunisation.
Since the decline of pertussis immunisation, hospital admission and death rates from whooping cough have fallen unexpectedly. Although this might be taken to indicate that the disease is becoming less severe, a comparison of admissions and deaths in England and Wales before and after the decline in immunisation suggests that several factors other than disease severity--a shift in the social class distribution of the disease, an increase in the proportion of milder cases notified, and improved care--were responsible for this. The severity of attacks and the complication rates in children admitted to hospital were virtually unchanged. Very young infants, those from disadvantaged families, and children with chronic illness were at greatest risk.
Bordetella pertussis↗
Alteration in pyruvate metabolism in the liver of tumor-bearing rats.
Weight loss associated with tumor burden has been postulated to be due to an energy imbalance resulting from increased hepatic gluconeogenesis secondary to Cori cycle activity. The mechanisms which control pyruvate metabolism are inherent to the control of gluconeogenesis in the liver. Therefore, the metabolism of pyruvate was evaluated in a transplanted tumor model in rodents which has previously shown an increased rate of hepatic gluconeogenesis. Female Lewis-Wistar rats received a s.c. injection of a suspension of mammary tumor cells in the left flank. Tumor-bearing rats were allowed ad libitum food consumption, and non-tumor-bearing controls were pair-fed to the consumption of their tumor-bearing cohorts. At Days 12, 13, and 14 following inoculation, tumor-bearing and non-tumor-bearing controls were used for in vivo body composition analysis or subjected to isolated liver perfusion. Animals were not fasted prior to sacrifice. Pyruvate use by the livers of tumor-bearing and pair-fed non-tumor-bearing rats was evaluated in the presence of 8 mM glucose and 5 mM lactate. Pyruvate clearance was increased by 270%, and pyruvate intake was increased by 212% compared to pair-fed non-tumor-bearing rats. Oxidation of pyruvate to CO2 was increased 130%, and pyruvate conversion to lactate was increased by 197% above that seen in pair-fed non-tumor-bearing rats. Gluconeogenesis from pyruvate was increased by 184% in tumor-bearing rats. The increased gluconeogenesis in tumor-bearing rats above that of control animals at a 5 mM lactate concentration suggests that some factor, other than substrate supply, may stimulate gluconeogenesis in tumor-bearing rats. Although the use of pyruvate was greater in tumor-bearing rats, the disposal of pyruvate carbon into CO2, lactate, and glucose was proportionally the same in both groups. Therefore, these data suggest that the increased metabolism of pyruvate in tumor-bearing rats is controlled by a mechanism affecting cellular pyruvate transport.
Animals↗