What works. Dictation system reduces transcription turnaround time by 40 percent.
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Alabama↗
Biomedical subjects
J Hicks
Publications and source records attributed to J Hicks.
Confidence in health care at what cost? Results from the 1998 Health Confidence Survey.
This Issue Brief presents the findings from the 1998 Health Confidence Survey. It focuses on Americans' satisfaction with the health care system and their confidence in the system's future. Only 5 percent of Americans give an excellent rating to health care in America today. However, while just over one-half rate health care as excellent, very good, or good, almost one-half (46 percent) rate it as fair or poor. When asked what they consider to be the most critical issue in America today, 15 percent of Americans cite health care. Overall, Americans are not extremely confident about various aspects of health care in the next 10 years. Only 10 percent are extremely confident that they will be able to get the medical treatments they need during this period, while 22 percent are not confident. Americans are even less confident that they will have access to quality health care (26 percent not confident), that they will have enough freedom to choose their health care provider (36 percent not confident), and that they will be able to afford health care without suffering financial hardship (41 percent not confident). The nonelderly population is even less confident about health care once they become eligible for Medicare. Americans are clearly confused about the meaning of managed care and whether they are enrolled in a managed care plan. While 70 percent of those who were determined to be enrolled in a managed care plan label the plan correctly, only 21 percent report that they are currently enrolled in a managed care plan. Most American have opinions about managed care. However, only 28 percent of Americans form their opinions about managed care based on their own personal experience. Twenty-three percent base their opinion on what they learn from family and friends, and 29 percent base it on what they hear or see in the media. While few Americans give managed care an excellent rating, few give it a poor rating. Most Americans rate managed care somewhere in the middle. Americans are particularly concerned about health care costs. Over 30 percent are not satisfied with the cost of their health insurance over the last 2 years, and 37 percent are not satisfied with the health care costs that are not covered by their health plan. These numbers compare with higher satisfaction levels concerning choice of physician, quality of care received, treatments received, hospitals used, and benefits covered by health plans.
Adult↗
What is your savings personality? The 1998 Retirement Confidence Survey.
This Issue Brief presents the findings of the 1998 Retirement Confidence Survey (RCS). The survey tracks Americans' retirement planning and saving behavior and their confidence regarding various aspects of their retirement. It also categorizes workers and retirees into six distinct groups, based on their very different views on retirement, retirement planning, and saving. The six personality types identified in the RCS are Deniers (10 percent of the population), Strugglers (9 percent), Impulsives (20 percent), Cautious Savers (21 percent), Planners (23 percent), and Retiring Savers (17 percent). The survey shows that working Americans have become more focused on retirement; 45 percent have tried to determine how much they need to save before they retire, up from 32 percent in 1996. Americans' growing attention to their retirement has not increased their retirement income confidence. Since 1993, the portion of working Americans who are very confident that they will have enough money to live comfortably throughout retirement has consistently ranged from 20 percent to 25 percent. Sixty-three percent of Americans have begun to save for retirement. Fifty-five percent of those not saving for retirement say it is reasonably possible for them to save $20 per week (over $1,000 per year). In addition, 57 percent of workers who have begun to save say that it is reasonably possible for them to save an additional $20 per week. The findings demonstrate the continuing need for broad-based educational efforts designed to make retirement savings a priority for individuals. The good news is the evidence that education can have a real impact at the individual level. For the first time the 1998 RCS examined retirement planning, saving, and attitudes across ethnic groups (African-Americans, Hispanic-Americans, Asian-Americans, and whites). African-Americans are the least confident that they will have enough money to live comfortably in retirement. African-Americans and Hispanic-Americans are less likely than whites and Asian-Americans to have saved any money for retirement. Among those saving for retirement, individuals' confidence that they are investing their retirement savings wisely does not differ among ethnic groups. Hispanic-Americans are less likely than whites and Asian-Americans to have made an attempt to determine how much money they will need to have saved by the time they retire.
Attitude↗
Safety in acupuncture. Core curriculum is important.
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Acupuncture Therapy↗
Measurement of a cross-sectional area of normal and stenotic arteries with videodensitometric quantitative arteriography and intravascular ultrasound.
RATIONALE AND OBJECTIVES: A videodensitometric technique that allows measurement of absolute cross-sectional area of any complex lesion was compared with an intravascular ultrasound (US) technique. METHODS: Stenotic devices (10-15 mm long) with cross sections of different shapes were placed in the distal aortas of five anesthetized pigs (weight, 40-50 kg). The stenotic devices were imaged by using an intravascular US probe after power injection of contrast material. RESULTS: A comparison of actual areas and measured cross-sectional areas of the stenotic devices showed that videodensitometry and intravascular US produced better results than edge-detection techniques for both unsubtracted and temporal subtraction images. CONCLUSION: These data suggest that the videodensitometric technique can be used to measure absolute cross-sectional areas of arteries with different shapes.
Absorptiometry, Photon↗
The relationship between leadership and sociometric status among preschool children.
In the present study the relationship between leadership behavior and sociometric status among preschool children was examined. Leadership behaviors of 24 6-year-old Japanese children were observed during free play and scored on the basis of a 2-dimensional leadership scale (facilitation of play and consideration-evaluation of playmates; Fukada, Fukada, & Hicks, 1994). Participants were categorized into three sociometric-status groups. Children who had high sociometric status showed higher scores on both leadership dimensions than those with low sociometric status.
Analysis of Variance↗
The introduction of renal biopsy into nephrology from 1901 to 1961: a paradigm of the forming of nephrology by technology.
'Biopsy' (Besnier 1895) became useful towards the end of the 19th century with the development of good histology and microbiology. Needle biopsy of the liver, although first performed in 1895, did not become current until 50 years later. Surgical biopsy of the kidney at incidental operations, particularly the then fashionable renal decapsulation, was performed from 1900 to 1930. Percutaneous needle renal biopsy was introduced after first, the successful liver biopsy and second, demonstration of the value of aspiration needle biopsy in tumours of the kidney. In addition, a number of physicians obtained renal tissue by accident and without problems during intended biopsies of the liver. Nils Alwall of Sweden performed the first systematic aspiration needle biopsies of the kidney in 1944, but did not publish his results because of an early death which led him to abandon the technique. However, when Iversen and Brun in Copenhagen described their results in 1951, a number of physicians around the world immediately began to attempt renal biopsy, using cutting as well as aspiration techniques. Success was inconsistent and operator dependent: the refinements of technique and needles introduced by the group in Chicago led by Robert Kark, plus their advocacy of the technique and their training of many physicians in its performance rapidly led to widespread acceptance. New techniques of immunofluorescence and electron microscopy arrived at the same time so that the technique could be fully exploited. The performance and interpretation of renal biopsies became, along with classical whole-organ and nephron physiology and the introduction of dialysis and transplantation, powerful agents determining the emergence of Nephrology as a specialty around 1960.
Biopsy, Needle↗
Quantification of volumetric coronary blood flow with dual-energy digital subtraction angiography.
BACKGROUND: As a solution to the well-documented problems associated with visual interpretation of coronary arteriograms, more physiological methods of assessing coronary artery stenosis are being investigated. Volumetric coronary blood flow (BF) can be a valuable aid in the analysis of functional significance of arterial obstruction. METHODS AND RESULTS: The left anterior descending coronary artery (LAD) of 15 anesthetized pigs (40 to 50 kg) was dissected free from the epicardium in its proximal portion, and a transmit-time ultrasound flow probe of the appropriate size was applied. A vascular occluder was positioned distal to the flow probe for flow adjustments. Contrast injections (2 to 4 mL/s for 3 seconds) were made into the left main coronary artery during image acquisition with a motion-immune dual-energy digital subtraction angiography (DE DSA) system. Tissue-suppressed energy-subtracted images were used to generate time-density curves. BF measurements were made in the LAD vascular bed with use of the time-density curve, with consideration that blood was momentarily replaced with contrast during the injection. In 19 comparisons, the mean BF, measured with the use of DE DSA, correlated extremely well with the mean ultrasound flow (DE DSA=0.90 ultrasound+3.10 mL/min, r=.96). Also, contrast injection increased the BF by an average of only 15% during the image-acquisition time interval. CONCLUSIONS: Accurate BF measurements can be made with motion-immune DE DSA. The BF measurements can be completed before the onset of significant changes in BF due to contrast injection. Furthermore, it is possible to make the BF measurements during routine coronary arteriography.
Angiography, Digital Subtraction↗
Autosomal dominant transmission of familial laterality defects.
Heterotaxy results from failure to establish normal left-right asymmetry during embryonic development. Most familial cases are thought to be autosomal recessive. We have identified a family in which 4 individuals from 3 generations manifest laterality defects. Twenty-five family members have been examined. Two have complete reversal of normal laterality (situs inversus) while 2 others have asplenia, midline liver, and complex cardiac malformations (situs ambiguus). Two additional obligate gene carriers are anatomically normal (situs solitus). Male-to-male transmission confirms autosomal inheritance. Identification of this family establishes an autosomal dominant form of laterality defect, suggesting that a portion of sporadic cases may be new-mutation dominant or unrecognized familial cases. The finding of all forms of laterality (solitus, ambiguus, and inversus) among obligate disease gene carriers within a single family may be relevant to genetic evaluation and counseling in apparently isolated patients with laterality disturbance.
Chromosome Aberrations↗
Frederick Akbar Mahomed and his role in the description of hypertension at Guy's Hospital.
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Blood Pressure Determination↗
Cancer detection activities coordinated by nursing students in community health.
This article describes ongoing cancer screening in a low-income and ethnically diverse community (primarily Southeast Asian and Hispanic). These services are part of the comprehensive care provided in a district nursing community health clinical. Screening services occur within the refugee community and include mammograms, individualized breast self-exam (BSE) teaching, home follow-up on the BSE teaching, and assistance obtaining any additional screening or treatment, if necessary. Except for technician activities, students plan, implement, and evaluate all services. The first event was in spring 1995, the second in summer 1995, and the third in fall 1995. Thus far, 85 women have received services. Cambodian and Laotian women show the lowest level of knowledge and experience related to breast cancer detection. This article provides some of the first data on cancer screening for low-income Cambodian and Laotian women in the United States. The article also shows how ongoing cancer screening and prevention services can be provided to populations that have not been successfully reached through usual means, e.g., referral by nurse practitioner, physician, and electronic or print media. Specific means of overcoming barriers to screening, prevention, and learning are described in detail.
Breast Neoplasms↗
Maximum cardiac performance of rainbow trout (Oncorhynchus mykiss) at temperatures approaching their upper lethal limit
Numerous studies have examined the effect of temperature on in vivo and in situ cardiovascular function in trout. However, little information exists on cardiac function at temperatures near the trout's upper lethal limit. This study measured routine and maximum in situ cardiac performance in rainbow trout (Oncorhynchus mykiss) following acclimation to 15, 18 and 22 °C, under conditions of tonic (30 nmol l-1), intermediate (60 nmol l-1) and maximal (200 nmol l-1) adrenergic stimulation. Heart rate increased significantly with both temperature and adrenaline concentration. The Q10 values for heart rate ranged from 1.28 at 30 nmol l-1 adrenaline to 1.36 at 200 nmol l-1 adrenaline. In contrast to heart rate, maximum stroke volume declined by approximately 20 % (from 1.0 to 0.8 ml kg-1) as temperature increased from 15 to 22 °C. This decrease was not alleviated by maximally stimulating the heart with 200 nmol l-1 adrenaline. Because of the equal and opposite effects of increasing temperature on heart rate and stroke volume, maximum cardiac output did not increase between 15 and 22 °C. Maximum power output decreased (by approximately 10-15 %) at all adrenaline concentrations as temperature increased. This reduction reflected a poorer pressure-generating ability at temperatures above 15 °C. These results, in combination with earlier work, suggest (1) that peak cardiac performance occurs around the trout's preferred temperature and well below its upper lethal limit; (2) that the diminished cardiac function concomitant with acclimation to high temperatures was associated with inotropic failure; (3) that Q10 values for cardiac rate functions, other than heart rate per se, have a limited predictive value at temperatures above the trout's preferred temperature; and (4) that heart rate is a poor indicator of cardiac function at temperatures above 15 °C.
Journal Article↗
Medicare managed care: numbers and trends.
This article captures some key trends in Medicare managed care. The figures which accompany this article explore, among other issues: enrollment; numbers of participating plans; demographic characteristics such as geographic location, age, and income; and premium and benefit comparisons.
Age Factors↗
Cataracts after bone marrow transplantation: long-term follow-up of adults treated with fractionated total body irradiation.
PURPOSE: To determine the risk of, and risk factors for, developing cataracts after bone marrow transplantation. METHODS AND MATERIALS: Four hundred and ninety-two adults who underwent bone marrow transplantation in Seattle were followed for 2 to 18 (median, 6) years. Before transplantation, patients received a preparative regimen of chemotherapy plus total body irradiation (TBI) (n = 407) or chemotherapy alone, without TBI (n = 85). TBI was administered in a single dose of 10 Gy (n = 74) or in fractionated doses totaling 12-15.75 Gy (n = 333). The risk of cataracts was determined for groups of patients with respect to the type of preparative regimen received and other pretransplant and posttransplant variables. RESULTS: One hundred and fifty-nine patients (32%) developed cataracts between 0.5 to 11 (median, 2.3) years after transplantation. The probability of cataracts at 11 years after transplantation was 85%, 50%, 34%, and 19% for patients receiving 10 Gy of single-dose TBI, > 12 Gy fractionated TBI, 12 Gy fractionated TBI, and no TBI, respectively (p < 0.0001). Among those developing cataracts, the severity was greater in patients after single-dose TBI (59% probability of surgical extraction) than after > 12 Gy fractionated TBI, 12 Gy fractionated TBI, or no TBI (33%, 22% and 23%, respectively). Patients given corticosteroids after transplant had a higher probability of cataracts (45%) than those without steroids (38%) (p < 0.0001). In a proportional hazards regression model, the variables that were correlated with an increased probability of cataracts were single-dose TBI (relative risk (RR) = 2.46) and steroid therapy (RR = 2.34), while a decreased probability of cataracts was correlated with a nonTBI preparative regimen (RR = 0.41). The yearly hazard of developing cataracts in recipients of single-dose TBI was highest during the third year after transplantation, while in recipients of fractionated TBI, the hazard was distributed among years one through seven. The probability of cataracts in all groups reached a plateau at 7 years after transplantation, after which the development of cataracts was extremely unlikely. CONCLUSION: TBI is the major risk factor for developing cataracts after BMT. Single-dose TBI results in the highest risk of cataracts. However, the risk of cataracts in recipients of fractionated-TBI is significantly higher than in patients who receive no TBI. In addition to TBI, steroid therapy is an independent risk factor for cataracts after BMT.
Adolescent↗
In-vivo validation of videodensitometric coronary cross-sectional area measurement using dual-energy digital subtraction angiography.
Previous studies indicate that conventional geometric edge detection techniques, used in quantitative coronary arteriography (QCA), have significant limitations in quantitating coronary cross-sectional area of small diameter (D) vessels (D < 1.00 mm) and lesions with complex cross-section. As a solution to this problem, we have previously reported on an in-vitro validation of a videodensitometric technique that quantitates the absolute cross-sectional area including small vessel diameter (D < 1.00 mm) and any complex shape of the vessel cross-section. For in-vivo validation, plastic tubing (5-8 mm long) with different shape complex cross-section with known cross-sectional area (A = 0.8-4.5 mm2) were percutaneously wedged in the coronary arteries of anesthetized pigs (40-50 kg). Contrast material injections (6-10 ml at 2-4 ml/sec) were made into the left main coronary artery during image acquisition using a motion immune dual-energy subtraction technique, where low and high X-ray energy and filtration were switched at 30 Hz. A comparison was made between the actual and measured cross-sectional area using the videodensitometry and edge detection techniques in tissue suppressed energy subtracted images. In eighteen comparisons the videodensitometry technique produced significantly improved results (slope = 0.87, intercept = 0.24 mm2, r = 0.94) when compared to the edge detection technique (slope = 0.42, intercept = 1.99 mm2, r = 0.39). Also, a cylindrical vessel phantom (D = 1.00-4.75 mm) was used to test the ability to calculate and correct for the effect of the out of plane angle of the arterial segment on the cross-sectional area estimation of the videodensitometry technique. After corrections were made for the out of plane angle using two different projections, there was a good correlation between the actual and the measured cross-sectional area using the videodensitometry technique (slope = 0.91, intercept = 0.11 mm2, r = 0.99). These data suggest that it is possible to quantitate absolute cross-sectional area without any assumption regarding the arterial shape using videodensitometry in conjunction with the motion immune dual-energy subtraction technique.
Angiography, Digital Subtraction↗
A novel P2-purinoceptor expressed by a subpopulation of astrocytes from the dorsal spinal cord of the rat.
1. Astrocytes from the dorsal spinal cord express P2-purinoceptors which, when stimulated, produce a rise in the intracellular level of free Ca2+ ([Ca2+]i). Previously we have found that the P2Y class of receptor is expressed by nearly all astrocytes from the dorsal horn. To determine whether other metabotropic P2-purinoceptor classes are also present, in this study we investigated the effects of UTP. 2. Application of UTP (1-500 microM, 5-20 s) produced a transient rise in [Ca2+]i in a subpopulation of astrocytes. The magnitude of the peak increase in [Ca2+]i was dependent upon UTP concentration and the EC50 was found to be 5.2 +/- 0.2 microM. Ca2+ responses were maximum at 100 microM UTP. 3. The rise in [Ca2+]i in response to UTP was not affected by removal of extracellular Ca2+. On the other hand, application of the sarcoplasmic-endoplasmic reticulum Ca(2+)-ATPase inhibitor, thapsigargin, abolished responses to UTP. These findings indicate that UTP stimulates the release of Ca2+ from a thapsigargin-sensitive intracellular pool. 4. The Ca2+ response to UTP was unaffected by treatment with pertussis toxin, suggesting that UTP responses may be mediated via a pertussis toxin-insensitive G protein. 5. While all cells tested (n = 52) responded to the P2Y-purinoceptor agonist, 2-methylthio-ATP, only a subpopulation of astrocytes (n = 67/93) was responsive to UTP. The presence of UTP-sensitive and UTP-insensitive cells requires the existence of two discrete types of receptor. One receptor, expressed by UTP-insensitive cells, appears to be activated selectively by 2-methylthio-ATP. 6. To investigate whether UTP and 2-methylthio-ATP activate a common type of receptor in UTP-responsive cells, a cross-desensitization strategy was used. Desensitization with prolonged exposure to a high concentration of 2-methylthio-ATP failed to affect responses to UTP and vice versa, indicating that receptors activated by UTP are distinct from those activated by 2-methylthio-ATP. 7. The P2-purinoceptor antagonist, suramin (100 microM), blocked Ca2+ responses to UTP and to 2-methylthio-ATP. 8. Pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid (PPADS), has been reported to block responses mediated by P2X- and P2Y-purinoceptors in other systems and therefore we investigated its effects on responses to 2-methylthio-ATP and to UTP. PPADS was found to block Ca2+ responses to 2-methylthio-ATP in a concentration-dependent manner with an IC50 of 0.92 +/- 0.1 microM. PPADS also blocked UTP-evoked responses and the IC50 was 7.2 +/- 1.9 microM. At a concentration of 10 microM, PPADS produced a rightward shift in the dose-response curve for UTP and did not affect the maximum response. 9. Calcium responses evoked by the muscarinic agonist, carbachol, were unaffected either by suramin (100 microM) or by PPADS (50 microM). 10. The present results indicate the presence of a novel class of metabotropic P2U-purinoceptor in dorsal spinal astrocytes. In contrast to P2Y-purinoceptors, the P2U-purinoceptor is expressed only by a subpopulation of astrocytes and its sensitivity to suramin and PPADS distinguish this receptor from P2U-purinoceptors found in other tissues.
Adenosine Triphosphate↗
Structure of leadership among preschool children.
The purpose of the present study was to examine the structure of leadership among preschool children. Leadership behaviors of 18 five-year-old Japanese children were observed during free play and scored on the basis of a 15-item leadership scale. A factor analysis of the items indicated two factors: facilitation of play and consideration-evaluation of playmates. Children who had a central role in group play showed more leadership behaviors on the consideration-evaluation of playmates dimension than those on the periphery. For the dimension of facilitation of play, however, no significant difference was seen between the two groups.
Child Behavior↗
A program to address the special needs of drug-exposed children.
The Ravenswood-Stanford Coalition for At-Risk Children promotes school success by intervening with K-3 students identified as drug-exposed, either prenatally or environmentally, enabling them to remain in regular classrooms rather than diverted to special education. This goal was accomplished through professional partnerships, home involvement, individual intervention plans, special school-based services, and mentorships. Results from the project indicate these children are not significantly different from their peers; home involvement promotes better school linkages and reinforces positive behavior change; appropriate short-term, school-based services can increase academic and behavioral performance; dedicated volunteers working individually with students accelerate change processes; and these special at-risk students must be assigned to caring, supportive, and predictable classrooms.
Child↗