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Biomedical subjects

J Bernstein

Publications and source records attributed to J Bernstein.

At least 19 recordsLinked to original sources
PubMed2001

Formal method for objective assessment of primate color.

To investigate primate color objectively, it is critical to employ tools that yield reliable measures of color samples. Primatologists have traditionally depended on color assessment methods that lack accuracy, precision, and replicability. In this work, we introduce the "red, green, and blue" (RGB) method, a technique combining digital video cameras and Adobe PhotoShop, as a means to assess and graphically represent primate color objectively. Here, we demonstrate the reliability and validity of the RGB method, and to outline the steps for assessing color samples, we report color measures obtained from the scrota of adult vervet monkeys.

Animals↗
PubMed2001

Physician-patient discussions of controversial cancer screening tests.

BACKGROUND: Screening mammography for younger women and prostate-specific antigen (PSA) measurement have controversial benefits and known potential adverse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how often these discussions take place or about barriers to these discussions. METHODS: We administered a survey to medical house staff and attending physicians practicing primary care. The survey examined physicians' likelihood of discussing screening mammography and PSA testing, and factors influencing the frequency and quality of these discussions. RESULTS: For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians' belief that PSA screening is advantageous; house staff and attending physicians' intention to order a PSA test, and attending physicians' intention to order a mammogram; and a controversial indication for screening. The most commonly identified barriers to discussions were lack of time, the complexity of the topic, and a language barrier. CONCLUSIONS: Physicians report they often do not discuss cancer screening tests with their patients. Our finding that physicians' beliefs and intention to order the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some patients may be inappropriately denied the opportunity to choose whether to screen for breast and prostate cancer.

Breast Neoplasms↗
PubMed2000

ATM heterozygosity and breast cancer: screening of 37 breast cancer patients for ATM mutations using a non-isotopic RNase cleavage-based assay.

Based upon the results of several epidemiologic studies, it has been suggested that women who are carriers for a mutation in the ataxia telangiectasia-mutated (ATM) gene are susceptible for the development of breast cancer. Therefore, 37 consecutive breast cancer patients were screened for the presence of a germline ATM mutation using a non-isotopic RNase cleavage-based assay (NIRCA). This paper reports the first use of NIRCA for detection of ATM mutations in breast cancer patients. Using this assay, no ATM mutations were found in our patient population. This result is similar to the findings of other studies that have employed approaches complementary to NIRCA.

Adult↗
PubMed2000

Ethics in sports medicine.

Sports medicine physicians are not exempt from the ethical challenges of medical practice merely because their patients are robust and healthy. In fact, precisely because the patients with sports injuries are so healthy the moral issues remain subtle. Many ethical issues in sports medicine come about because the traditional relationship between doctor and patient is altered or absent. In the current review, several routine topics in biomedical ethics, including doctor and patient confidentiality, informed consent, the care of minors, medical advertising and use of innovative treatments, will be studied from the sports medicine perspective. Hypothetical case histories will be presented, along with an analysis of the underlying ethical issues. The goal of this analysis is not to offer answers to these moral questions, but to increase awareness and promote contemplation of the correct course of action.

Athletic Injuries↗
PubMed2000

Evaluating the source and content of orthopaedic information on the Internet. The case of carpal tunnel syndrome.

BACKGROUND: The Internet has become a popular source of medical information for patients. Authors of health-related web pages are not required to adhere to any standard for medical content or accuracy. The goal of the present study was to assess the type, quality, and reliability of information about carpal tunnel syndrome that is available on the Internet. METHODS: The search phrase "carpal tunnel syndrome" was entered into five commonly used World Wide Web search engines. The search results then were given as an ordered list of universal resource locators, or web-site addresses. The top (first) fifty web sites from each of the five searches were combined to create a master roster of 250 web-site addresses. These web sites then were evaluated for authorship and content, and an informational value score ranging from 0 to 100 points was assigned to each. RESULTS: Thirty-three percent of the sites sold commercial products for the evaluation or treatment of carpal tunnel syndrome. An additional 30 percent were commercial web sites that did not sell products. Only 23 percent of the sites were authored by a physician or an academic organization. Fewer than half of the sites offered conventional information. Twenty-three percent of the sites offered unconventional or misleading information. The mean informational value of the web sites was 28.4 of a possible 100 points. CONCLUSIONS: The information about carpal tunnel syndrome on the Internet is of limited quality and poor informational value. The public and the medical communities need to be aware of these limitations so that the quality of medical information available on the World Wide Web can be improved.

Carpal Tunnel Syndrome↗
PubMed2000

Graph-set analysis of hydrogen-bond patterns: some mathematical concepts

To provide a foundation for further theoretical and software development of the application of graph sets to patterns of hydrogen bonding and other intermolecular interactions a number of mathematical concepts and tools are defined, developed and demonstrated. Following a review of the basic definitions and uses of graph sets, the directional properties of hydrogen bonds are now included in the treatment. The concepts of a constructor graph and covalent distance matrix have been developed to aid in the generation of a qualitative descriptor for the straightforward, consistent and ultimately automatic (with appropriate software) definition of patterns. An additional mathematical tool, the arrowed T-labeling, has been developed to deal with situations in which pattern-forming moieties are located on crystallographic special positions. To demonstrate the utility and various features of these concepts they are applied in detail to two particular structures, polymorphic iminodiacetic acid [N-(carboxymethyl)glycine] and trans-tetraamminedinitrocobalt(III) acetate. To facilitate the application and use of graph sets many of these developments have already been incorporated into the software of the Cambridge Structural Database, as described in the accompanying paper.

Journal Article↗
PubMed2000

[Repair of female urinary incontinence with prolene "TVT": preliminary results of a multicenter and prospective survey].

OBJECTIVES: A multicentre, prospective study (6 private centres, 1 general hospital and 1 teaching hospital) was conducted to evaluate the perioperative morbidity and short-term functional results of the TVT procedure in the treatment of the female urinary stress incontinence. PATIENTS AND METHODS: From November 1996 to September 1999, 120 patients with a mean age of 65.2 years (range: 37-91) were operated according to the tension-free vaginal tape (TVT) technique for isolated urinary stress incontinence (stage 2 or 3) in 94 cases and associated with pelvic tone disorder in 26 cases. 59 patients (49.2%) presented recurrence of urinary incontinence that had already been operated between 1 and 4 times. Physical examination demonstrated hypermobility of the urethra in 73 cases (60.8%), isolated clinical sphincter incompetence in 47 cases (39.2%) and pelvic tone disorders in 31 cases. Urodynamic studies, performed in 113 patients, demonstrated sphincter incompetence in 65 cases (57.5%) with a mean maximum urethral closure pressure of 18 cmH2O (range: 5-29). RESULTS: The operation, performed under spinal anaesthesia in 97 cases (80.8%), general anaesthesia in 16 cases (13.3%) and local anaesthesia in 7 cases (5.8%) lasted an average of 28.7 min (range: 15-60) for insertion of the TVT. Perioperative complications consisted of twelve bladder injuries (10%) and two pelvic haematomas (1.7%). No cases of infection, erosion or migration of the tape were reported. In the group of 94 patients operated exclusively by TVT, the mean hospital stay was 2.6 days (range: 1-7). Twelve patients (10%) required self-catheterization for 2 to 30 days. With a mean follow-up of 15.2 months (range: 36-6), continence was restored in 104 patients, corresponding to a cure rate of 86.7%. A marked improvement was obtained in 11 cases (9.2%) and five cases (4.2%) were considered to be failures. CONCLUSION: The TVT procedure is a new approach to the treatment of female urinary stress incontinence. Its advantages are its simplicity, the rapidity of the technical procedure and the short-term efficacy on continence. A longer follow-up is essential to assess to the functional outcome and the long-term urethral tolerance.

Adult↗
PubMed1999

Concomitant Polymorphs.

The simultaneous appearance of polymorphs of a substance has long been recognized but rarely noted or systematically studied. This phenomenon can be useful in the investigation of solid materials and in understanding the relative crystal energetics of polymorphic materials. This review covers the thermodynamic and kinetic factors that govern competitive and concomitant polymorphic crystallization. One of the many examples surveyed is a cyanine/oxonol complex, for which different relative molecular orientations in two of the many reported polymorphs are shown.

Journal Article↗
PubMed1999

Graph-set analysis of hydrogen-bond patterns: some mathematical concepts.

To provide a foundation for further theoretical and software development of the application of graph sets to patterns of hydrogen bonding and other intermolecular interactions a number of mathematical concepts and tools are defined, developed and demonstrated. Following a review of the basic definitions and uses of graph sets, the directional properties of hydrogen bonds are now included in the treatment. The concepts of a constructor graph and covalent distance matrix have been developed to aid in the generation of a qualitative descriptor for the straightforward, consistent and ultimately automatic (with appropriate software) definition of patterns. An additional mathematical tool, the arrowed T-labeling, has been developed to deal with situations in which pattern-forming moieties are located on crystallographic special positions. To demonstrate the utility and various features of these concepts they are applied in detail to two particular structures, polymorphic iminodiacetic acid [N-(carboxymethyl)glycine] and trans-tetraamminedinitrocobalt(III) acetate. To facilitate the application and use of graph sets many of these developments have already been incorporated into the software of the Cambridge Structural Database, as described in the accompanying paper.

Journal Article↗
PubMed1999

6-oxa isosteres of anacardic acids as potent inhibitors of bacterial histidine protein kinase (HPK)-mediated two-component regulatory systems.

A series of 6-oxa isosteres of anacardic acids (6-higher alkyl/alkenyl-2-hydroxybenzoic acids) was synthesised and several members were discovered to be among the most potent inhibitors (IC50 values < or = 5 microM) of the bacterial two-component regulatory systems, KinA/SpoOF and NRII/NRI, reported to date. The Gram-positive antibacterial activity in selected strains is also presented.

Anacardic Acids↗
PubMed1999

Piperacillin/tazobactam plus tobramycin versus ceftazidime plus tobramycin for the treatment of patients with nosocomial lower respiratory tract infection. Piperacillin/tazobactam Nosocomial Pneumonia Study Group.

An open-label, randomized, comparative, multi-centre study was conducted at 25 centres in the USA and Canada to compare the safety and efficacy of piperacillin/tazobactam plus tobramycin with ceftazidime plus tobramycin in patients with lower respiratory tract infections. Piperacillin/tazobactam (3 g/375 mg) every 4 h or ceftazidime (2 g) every 8 h were administered i.v. for a minimum of 5 days. Tobramycin (5 mg/kg/day) given in divided doses every 8 h was administered to all patients. Patients with Pseudomonas aeruginosa isolated from respiratory secretions at baseline were to continue tobramycin for the duration of the study. Tobramycin could be discontinued in other patients after the baseline culture results were known. A total of 300 patients was randomized, 155 into the piperacillin/tazobactam group and 145 into the ceftazidime group. Of these, 136 patients (78 in the piperacillin/tazobactam group and 58 in the ceftazidime group) were considered clinically evaluable. Both groups were comparable for age, sex, duration of treatment and other demographic features. The clinical success rate in evaluable patients was significantly greater (P = 0.006) in the piperacillin/tazobactam treatment group (58/78; 74%) than in the ceftazidime group (29/58; 50%). Eradication of the baseline pathogen was significantly greater (P = 0.003) in the piperacillin/tazobactam group (66%) than in the ceftazidime group (38%). The clinical and bacteriological responses of those patients with nosocomial pneumonia were similar to the overall results. Twelve (7.7%) piperacillin/tazobactam-treated patients and 24 (17%) ceftazidime-treated patients died during the study (P = 0.03). Seven of the 24 deaths in the ceftazidime treatment group but only one of the 12 deaths in the piperacillin/tazobactam treatment group were directly related to failure to control infection. The majority of adverse events were thought by the investigator to be attributable to the patients' underlying disease and not drug related. In this study, piperacillin/tazobactam plus tobramycin was shown to be more effective and as safe as ceftazidime plus tobramycin in the treatment of patients with nosocomial LRTI.

Adolescent↗
PubMed1999

Body mass and fracture risk. A study of 330 patients.

Low body mass is a major risk factor for low energy hip fractures among women. The purpose of this study was to ascertain whether normal body mass also protects against low energy wrist fractures. A retrospective analysis of body mass indices of 330 women who sustained hip or wrist fractures from falls was performed. Data were grouped by race and age. The mean body mass index for white patients with wrist fractures was 26.4, compared with a mean body mass index of 22.3 in white patients with hip fractures. For black patients, those with wrist fractures had a mean body mass index of 28.5, compared with a mean body mass index of 22.9 for those with hip fractures. Using data from The National Health and Nutrition Examination Surveys, the mean body mass index of patients with wrist fractures was seen to be equal to or greater than the national mean body mass index, whereas that of patients with hip fractures was substantially below average. Accordingly, normal body mass was protective against hip fractures but not against wrist fractures. Because adipose tissue more typically is distributed about the hip than the wrist, the protective mechanism of normal body mass against osteoporotic fractures may promote better preventative interventions against this disease.

Accidental Falls↗
PubMed1999

Sabbatical programs and the status of academic emergency medicine: a survey.

OBJECTIVES: The Society for Academic Emergency Medicine (SAEM) commissioned a survey in 1998 to describe sabbatical programs, academic rank, and tenure, and to shed light on factors affecting the continuum of faculty development, as a context for evaluating the potential importance of emergency medicine (EM) sabbatical programs. METHODS: The chairs of 120 EM residency programs were surveyed. RESULTS: The response rate was 90%. Of 108 responses, 44 were academic EM departments (AEMDs); ten were their affiliates. The setting was urban for 82%; 37% were publicly funded and 58% privately. AEMDs were more likely to have a tenure track and eligibility for a sabbatical program, but not more likely to use a sabbatical program. Among 2,042 ranked EM faculty, there were 121 professors and 346 associate professors. Mean sabbatical length was six months, provided at full pay requiring a mean of 5.7 years of employment. Among 39 programs reporting eligibility for an EM sabbatical, requirements included: tenure (43%), academic rank of associate professor (78%), an application with multiple approval levels (92%), and a formal report (75%). Thirteen EM programs used sabbaticals; only 40 faculty members altogether (9% of senior faculty) have taken sabbaticals. The mean value of sabbaticals (rated by users on a scale of 1 to 10) was 6.8. Reduced funding, lack of departmental status, difficulty retaining faculty, Health Care Financing Administration (HCFA) regulations, graduate medical education (GME) cutbacks, and no release time were identified as challenges for emergency physicians (EPs) wishing to participate in sabbaticals. Strategies proposed to overcome these obstacles include quality customer service, streamlined operations, outside contracts, computerization, hiring individuals with PhDs, collaboration, political activity, and faculty development. CONCLUSIONS: A sabbatical can be beneficial for individuals and their institutions, but presently EPs have not been able to maximize use of available opportunities. Some obstacles to successful participation of EM in sabbatical programs might be overcome with creative strategies and the active support of professional academic organizations.

Career Mobility↗