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Biomedical subjects

J Cassidy

Publications and source records attributed to J Cassidy.

At least 127 records · Page 7Linked to original sources
PubMed1994

The insecure/ambivalent pattern of attachment: theory and research.

Relatively little has been written about one group of infants identified with Ainsworth's "Strange Situation" assessment of infant-parent attachment, those classified insecure/ambivalent. Although virtually all samples contain some insecure/ambivalent infants, these infants are uncommon, comprising 7%-15% of most American samples. Recently developed assessments of attachment in children and adults have identified attachment groups of older individuals thought to parallel the insecure/ambivalent infant group. Empirical work in which insecure/ambivalent individuals are examined as a separate group is reviewed within the context of attachment theory, and a coherent picture emerges of the antecedents (relatively low or inconsistent maternal availability; biological vulnerability) and sequelae (limited exploratory competence) of this group. This picture is used as the basis for additional theoretical proposals, and suggestions for future research are presented.

Adaptation, Psychological↗
PubMed1994

Emotion regulation: influences of attachment relationships.

Emotion regulation and quality of attachment are closely linked. It has been proposed here that one influence on individual differences in emotion regulation may be a child's attachment history. Individuals characterized by the flexible ability to accept and integrate both positive and negative emotions are generally securely attached; on the other hand, individuals characterized by either limited or heightened negative affect are more likely to be insecurely attached. While acknowledging the role of infant temperament, I have focused on the role of social factors in examining the link between emotion regulation and attachment. The approach to emotion regulation taken here--that emotion regulation is adaptive in helping a child attain her goals--is esentially a functionalist approach (Bretherton et al., 1986; Campos et al., 1983), consistent with earlier views of emotions as important regulators of interpersonal relationships (Charlesworth, 1982; Izard, 1977). It has been proposed that patterns of emotion regulation serve an important function for the infant: the function of maintaining the relationship with the attachment figure. Emotion regulation has been described as serving this function in two ways. First, the function of maintaining the relationship is thought to be served when infant emotion regulation contributes to the infant's more generalized regulation of the attachment system in response to experiences with the caregiver. Infants who have experienced rejection (insecure/avoidant infants) are thought to minimize negative affect in order to avoid the risk of further rejection. Infants whose mothers have been relatively unavailable or inconsistently available (insecure/ambivalent infants) are thought to maximize negative affect in order to increase the likelihood of gaining the attention of a frequently unavailable caregiver. Both these patterns of emotion regulation help ensure that the child will remain close to the parent and thereby be protected. Second, the function of maintaining the attachment relationship is thought to be served when the infant signals to the parent that she will cooperate in helping maintain the parent's own state of mind in relation to attachment. The minimizing of negative affect of the avoidant infant signals that the infant will not seek caregiving that would interfere with the parent's dismissal of attachment. The heightened negative emotionality of the ambivalent infant signals to the parent that the infant needs her and thus helps maintain a state of mind in which attachment is emphasized. The approach to emotion regulation presented here is congruent with much work examining the socialization of emotions (Lewis & Saarni, 1985; Thompson, 1990).

Affect↗
PubMed1994

New drugs in clinical development in Europe.

This article deals with new antitumor agents currently in Phase I or II evaluation in various European centers. Drugs reviewed in this article include Taxotere, Camptothecin analogues, CPT-11, and Topotecan. Rhizoxin, D1694, and Bryostatin are among other agents reviewed in this article.

Antineoplastic Agents↗
PubMed1993

Phase I and pharmacokinetic study of taxotere (RP 56976) administered as a 24-hour infusion.

N-Debenzoyl-N-tert-butoxycarbonyl-10-deacytyl taxol (Taxotere, RP 56976) is a semisynthetic analogue of taxol, prepared from a noncytotoxic precursor extracted from the needles of the European yew tree (Taxus baccata L.). It has a broad spectrum of antitumor activity against a variety of transplantable tumors in mice. In vitro cytotoxicity assays suggest that it is 2-5-fold more potent than taxol. In this phase I study Taxotere was administered by 24 h i.v. infusion at 3-week intervals. Thirty patients with solid tumors refractory to conventional therapy were treated; 70 courses of Taxotere were administered at doses ranging from 10 to 90 mg/m2. Grade 4 neutropenia and grade 3 mucositis were dose limiting but reversible at 90 mg/m2. The pattern and grade of toxicity at this dose were similar in 3 heavily pretreated patients compared with 7 patients who had received a maximum of one previous chemotherapy regimen. Alopecia occurred at 55 mg/m2 and above. Other mild toxicities included phlebitis, diarrhea, emesis, and sensory peripheral neuropathy, but these were neither dose-limiting nor clearly dose-related. One patient treated at 70 mg/m2 had an anaphylactoid reaction following the second dose of Taxotere. No cardiovascular toxicity was observed. No partial or complete responses were documented. Plasma concentrations of Taxotere were determined by high-performance liquid chromatography, and end-of-fusion levels at the maximum tolerated dose exceeded drug concentrations which are cytotoxic in vitro. The maximum tolerated dose for Taxotere administered as a 24-h infusion is 90 mg/m2.

Adult↗
PubMed1993

Phase I clinical study of LL-D49194 alpha 1 with retrospective pharmacokinetic investigations in mice and humans. The EORTC ECTG.

LL-D49194 alpha 1 is a new cytotoxic antibiotic selected for clinical phase I study because of its impressive pre-clinical anti-tumour activity and its low toxicity profile in experimental animals. A total of 15 patients were treated in centres in Glasgow and Amsterdam at doses ranging from 0.25 to 4 mg/m2. One minor response was noted in a patient with colonic carcinoma. The study was suspended following the discovery of unexpected cardiotoxicity. As this toxicity was not consistent with the standard (EORTC) European Organisation for Research and Treatment of Cancer toxicology profile, we chose to investigate the pharmacokinetics of LL-D49194 alpha 1 in mice and humans in more detail to try to explain this phenomenon. A major difference in plasma protein binding was discovered between mice and patients, with a suggestion of non-linear kinetics being noted at higher doses in humans. It is likely that these differences in drug handling account for the unexpected and serious toxicity encountered in this trial.

Aged↗
PubMed1993

Human transbuccal absorption of diclofenac sodium from a prototype hydrogel delivery device.

The buccal delivery of the nonsteroidal antiinflammatory drug, diclofenac sodium (Voltaren), from a prototype hydrogel was studied in man in a randomized crossover design of buccal delivery and i.v. infusion. After a 30-min delay, plasma levels of diclofenac increased to near steady-state levels of 100 ng/ml by 3 hr. With each subject serving as his own control, the i.v. infusion data facilitated the calculation of a mean steady-state flux of diclofenac sodium of 2.1 +/- 0.6 mg/cm2-hr across human buccal mucosa and a time lag of 1.0 +/- 0.5 hr. The large flux of this ionized species indicates that the traditional lipoidal model of buccal permeation based on the partition coefficient is inadequate.

Absorption↗
PubMed1993

Network unites payers, physicians, hospitals. System participants work together to improve access to care and to design cost-saving incentives.

Through Sacred Heart Health System (SHHS), Eugene, OR, physicians, payers, and hospitals are designing a network that will integrate care and improve access by reducing healthcare costs. Together, system members design cost-saving incentives and the products the system offers the community. They promote managed care as the most efficient means to coordinate care and reduce costs. All participants share in the risks of a capitated payment system. Since the system pulled together the payers, physician groups, and hospitals, many of these entities' management functions were consolidated at the system level to avoid duplication and reduce administrative costs. Bringing in physicians was the most difficult yet important aspect of forming a successful network. Working with two physician groups in the community, the system's sponsor-the Sisters of St. Joseph of Peace, Health and Hospital Services-developed the Physician Practice Board. The board, representing 300 physicians, meets weekly and makes recommendations on issues that affect physicians. SHHS also added innovative new functions such as an integrated medical cost management and continuous quality improvement program. Another key to success is a clinically oriented information system, which will allow the system to track patients once they leave the hospital. It also will provide a better understanding of what things have an impact on outcomes and will reduce paperwork. A portion of the system's revenue is designated for initiatives to improve access. And the system recently appointed a tack force on access to explore what they can do in cooperation with others in the community.

Capitation Fee↗