Factors related to couples' decisions to attempt in vitro fertilization.
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Adult↗
Biomedical subjects
J Mitchell
Publications and source records attributed to J Mitchell.
Antagonism of [3H]fatty acid incorporation into vimentin by sodium pyruvate: pitfalls of protein acylation.
In the course of studying possible fatty acid acylation of vimentin by cultured bovine lens epithelial cells, several potential pitfalls of protein-fatty acid acylation were recognized. Even exhaustive delipidation of vimentin with organic solvents failed to remove all noncovalently associated [3H]palmitate and [3H]myristate. Hydroxylamine treatment of vimentin, separated by sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE), failed to remove either palmitate or myristate derived radiolabel. Hydroxylamine treatment did remove palmitate label from a group of lower molecular weight proteins. The myristate radiolabel associated with vimentin recovered after SDS-PAGE and subjected to acid hydrolysis was shown due to incorporated [3H]amino acids, mainly glutamic acid, generated from the fatty acid. Adding excess sodium pyruvate to labeling media has been used by others to reduce the metabolic conversion of fatty acids to amino acids; however, no direct evidence in support of this antagonism was presented. We observed that inclusion of sodium pyruvate at between 5 and 20 mM in the labeling medium produced a dramatic decrease in incorporation of myristic acid radiolabel into vimentin. However, inclusion of even 20 mM pyruvate did not completely antagonize the metabolic conversion of fatty acid label to amino acids. Furthermore, the sodium pyruvate antagonism could be totally obscured if the exposure of X-ray film by fluorography was even slightly prolonged. The results illustrate the danger in assuming that solvent extraction totally delipidates proteins and that adding sodium pyruvate to labeling media prevents the transfer of fatty acid label to amino acids.(ABSTRACT TRUNCATED AT 250 WORDS)
Amino Acid Sequence↗
Sotalol and type IA drugs in combination prevent recurrence of sustained ventricular tachycardia.
OBJECTIVES: This study assessed the efficacy of the combination of sotalol and either quinidine or procainamide in preventing sustained ventricular tachycardia inducibility and recurrence and prospectively evaluated the ability of the drug combination to prevent ventricular tachycardia recurrence when the arrhythmia remained inducible but was modified. BACKGROUND: Individual antiarrhythmic drugs are often ineffective in preventing the induction and recurrence of sustained ventricular tachycardia. Beta-adrenergic blockade and prolongation of refractoriness may be important components of successful antiarrhythmic therapy in patients with ventricular tachycardia. We reasoned that the combination of sotalol, which has beta-adrenergic blocking properties and prolonged ventricular refractoriness, and quinidine or procainamide, two agents that slow conduction and prolong refractory periods, would be effective therapy in such patients. METHODS: We administered low dose sotalol (205 +/- 84 mg/day) plus quinidine sulfate (1,278 +/- 479 mg/day) or procainamide (2,393 +/- 1,423 mg/day) to 50 patients with spontaneous sustained ventricular tachycardia or fibrillation and inducible ventricular tachycardia. RESULTS: In 21 (46%) of 46 patients, ventricular tachycardia was rendered noninducible at electrophysiologic study (group I), and in 17 patients (37%), inducible tachycardia was modified according to prospectively identified criteria (group II), for a combined 83% response rate. Ventricular refractory periods increased from 252 +/- 24 to 316 +/- 28 ms and from 265 +/- 33 to 316 +/- 24 ms in groups I and II, respectively (p < 0.001), but from 234 +/- 19 to only 286 +/- 13 ms in the group of patients with unmodified ventricular tachycardia inducibility (n = 8, group III, p < 0.001). Cycle length of induced ventricular tachycardia slowed from 324 +/- 62 to 432 +/- 70 ms in group II patients (p < 0.001), whereas it slowed less in group III patients (279 +/- 73 to 314 +/- 63 ms, p = NS). Forty-two of the 50 patients (including all patients in groups I and II) were discharged on treatment with the drug combination. After 25 +/- 19 months of follow-up, the actuarial recurrence rate of ventricular tachycardia was 6%, 6% and 11% at 1, 2 and 3 years, respectively. Among patients in whom this drug combination was unsuccessful at electrophysiologic study (group III) and in those who received alternative therapy after combination therapy was discontinued because of side effects, actuarial recurrence rates were 9%, 14% and 32% at 1, 2 and 3 years, respectively. CONCLUSIONS: The combination of sotalol plus quinidine or procainamide markedly prolongs ventricular refractoriness and slows induced ventricular tachycardia in a high proportion of patients. Patients with modified or noninducible tachycardia have a low rate of arrhythmia recurrence in follow-up. This drug combination deserves further evaluation.
Aged↗
Analgesic efficacy and potency of two oral controlled-release morphine preparations.
MS Contin tablets and Oramorph SR tablets are two forms of oral controlled-release morphine sulfate available for the alleviation of pain. Our objective was to compare their analgesic effects in a relative potency assay. In this study, 151 patients undergoing caesarean section or abdominal hysterectomy and reporting moderate or severe postoperative pain received a 30 or 90 mg dose of either drug in a balanced, randomized, double-blind, parallel-group, single-dose experimental design. Patients provided self-ratings of analgesia. Relative potency for pain relief were calculated from log dose-effect curves. For total pain relief (rated by visual analog scales) over 12 hours, the log dose relative potency estimate for MS Contin tablets/Oramorph SR tablets was 1.9 (95% confidence limits, 0.89 to 11.1); for peak pain relief (visual analog scales) the relative potency estimate was 1.7 (95% confidence limits, 0.65 to 48.3). Overall, the 90 mg dose of MS Contin was more effective than 30 or 90 mg doses of Oramorph SR and the 30 mg dose of MS Contin at hours 6 to 12. Adverse experiences (mainly drowsiness) were mostly mild to moderate, with no significant differences in their overall incidence or severity between equivalent doses. MS Contin tablets provided greater peak, total, and duration of analgesia, without higher incidence of adverse experiences.
Administration, Oral↗
Depression in young people: initial presentation and clinical course.
OBJECTIVE: This project was designed to provide prospective data on the clinical presentation and longitudinal course of depression in children and adolescents. METHOD: Children and their parent(s) completed a structured diagnostic interview (Schedule for Affective Disorders and Schizophrenia for School Age Children) at intake, and then yearly for 3 years. Collateral data were collected on school, social, and family functioning. RESULTS: Mean length of initial depressive episode was 35.6 weeks, SD of 26 weeks. Of the 65 depressed youths who completed the 3-year follow-up, 35 (54%) disclosed another episode of depression. Demographic, family-environment, and diagnostic variables were explored as predictors of characteristics of initial episode, recurrence of depression, and psychosocial competence at follow-up. Female gender and presence of a coexisting anxiety disorder were significantly related to severity of initial depression. Family environment was the only predictor significantly related to overall psychosocial competence over 3 years. CONCLUSIONS: The findings confirm depression in youth as a valid clinical phenomenon, with substantial risk of recurrence. Increased levels of stress in the family environment were associated with poorer overall outcomes.
Anxiety Disorders↗
Serum albumin and prealbumin as predictors of clinical outcomes of hospitalized elderly nursing home residents.
OBJECTIVE: To investigate the prevalence of hypoalbuminemia and hypoprealbuminemia in hospitalized, elderly, skilled nursing facility residents and to correlate these findings with clinical outcomes. DESIGN: Prospective cohort study. SETTING: A 300-bed community hospital. PARTICIPANTS: Eighty-one hospitalized, skilled nursing facility patients, average age 83.1 years. INTERVENTIONS: None. OUTCOME MEASURES: Serum albumin and prealbumin (transthyretin) were measured at admission, mid-week, 1 week, and 1 month. Patients were followed for 90 days for the outcomes of length of hospitalization and mortality. RESULTS: The prevalence of hypoalbuminemia was 99% and of hypoprealbuminemia, 79%. Both means dropped significantly from admission to midweek nadirs of 25 g/L for albumin and 14 mg/L for prealbumin. Severe hypoalbuminemia at mid-week predicted mortality (RR = 4.1 95%, CI 2.0-8.5) and extended length of hospitalization (RR = 5.2 95%, CI 2.8-9.8). Severe hypoprealbuminemia predicted extended hospitalization (RR = 3.2, CI 1.5-6.7) but not mortality. CONCLUSIONS: Hypoalbuminemia and hypoprealbuminemia are very common in this clinical setting and vary in parallel fashion over time. Severe hypoalbuminemia was a stronger predictor than hypoprealbuminemia of 90-day mortality and extended length of stay. Serum albumin on admission was not as strong a predictor of outcomes as serum albumin at mid-week.
Aged↗
Rett syndrome and the 4th metatarsal.
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Child, Preschool↗
What young people think and do when the option for cystic fibrosis carrier testing is available.
We report findings in phase II of a pilot study of cystic fibrosis (CF) carrier screening/testing by mutation analysis. Phase I has been reported elsewhere. Eligible participants in phase II (n = 815) were students (15 to 17 years of age) in public high schools. An educational component (exchange of information and discussion about common genetic disorders including CF) preceded, by one week or more, voluntary participation in the screening component which required a blood sample. The uptake rate for screening was 42%. Nine carriers (2pq = 0.0260) were identified, all with the delta F508 mutation; students were also tested for G551D, G542X, W1282X, and -549-mutations, but no carriers of these alleles were found. Carriers had positive views of the education and testing experiences. Persons identified as 'non-carriers' were also surveyed (n = 135, response rate 41%). As in phase I, the majority (83%) again understood that a negative DNA test had not excluded them from possible carrier status. Students who participated in the informational component but were not screened served here as controls in the follow up survey (n = 208, response rate 53%). Their views were similar to those of the screened non-carriers, and similar also to those held by students, adults, pregnant women, couples, and CF relatives in other communities.
Adolescent↗
Smooth muscle myosin regulation by serum and cell density in cultured rat lung connective tissue cells.
RNA and protein analyses were used to detect expression of SM1 and SM2 smooth muscle myosin heavy chain (MHC) in cultured adult rat lung connective tissue cells (RL-90). Smooth muscle MHC mRNA expression in confluent cells grown in 10% serum was approximately 50% of the level in adult stomach. Similar results were obtained in cells cultured at low density (25% confluency) in 1% serum. However, in low-density cultures transferred to 10% serum for 24 h, the level of MHC mRNA decreased to approximately 20% of that in adult stomach. Smooth muscle alpha-actin showed a pattern of expression similar to that for smooth muscle MHC. Expression of nonmuscle MHC-A mRNA was higher in all culture conditions compared to stomach. MHC-A mRNA expression was less in low-density cultures in low serum and increased when low-density cultures were transferred to 10% serum for 24 h. MHC-B mRNA expression was less in low- vs. high-density cultures. In contrast to MHC-A, however, MHC-B mRNA expression in low-density cultures was higher in low serum. Immunofluorescence and immunoblotting with SM1-specific antibody demonstrated the presence of the SM1 protein isoform as well as reactivity to a protein band migrating slightly faster than SM2. These results demonstrate that cultured rat lung connective tissue cells express smooth muscle MHC and that expression is modulated by culture conditions.
Amino Acid Sequence↗
Myosin isoform expression in developing and remodeling rat lung.
The tissue distribution of myosin isoforms was examined in developing smooth muscle of rat lung. Antisera employed included a general smooth muscle myosin antibody (aSMMG) and two smooth muscle myosin isoform specific antisera (aSM1 and aSM2). In the pseudoglandular, canalicular, and saccular lung, the isoform-specific aSM1 antiserum was very lightly reactive only with large airway and not reactive with vascular smooth muscle, whereas aSM2 was unreactive with any lung cells. During these same stages, the aSMMG serum reacted well with the mesenchymal coat around the larger airways, declining in intensity as the tube size diminished. Vascular smooth muscle elements had only moderate reactivity at this time. In the adult, aSM1 marked airway smooth muscle as well as the tips of the alveolar septae. Vascular reactivity was seen in both arterial and venous elements. An identical distribution of reactivity was seen for aSMMG. aSM2 reactivity appeared confined primarily to airway smooth muscle and was absent from all but the largest vascular structures. Companion Western blot analyses confirmed the presence of SM1 in fetal and mature tissues as well as the relative lack of SM2 in all but the fully differentiated airways. Lung injury due to intratracheal instillation of bleomycin is characterized by a proliferation of mesenchymal cells similar to immature smooth muscle cells. These cells express smooth muscle forms of actin but lacked the mature smooth muscle myosin isoforms. In summary, differentiation of smooth muscle in the lung proceeds with progressive replacement of nonmuscle isoforms of myosin with differentiation-specific forms. In this regard, the maturation of vascular muscle tissue lags behind that of nonvascular (visceral) muscle structures.(ABSTRACT TRUNCATED AT 250 WORDS)
Amino Acid Sequence↗
HIMAA workforce survey 1991/1992.
In 1991, and again in 1992, the Health Information Management Association of Australia (HIMAA), formerly Medical Record Association of Australia (MRAA), distributed a Workforce Survey to all members to collect information about the demographic, professional and employment characteristics of HIMAA members. There was a response rate 66.8% in 1991 and 40% in 1992, which rise to 80.9% in 1991 and 51.7% in 1992 for responses from full members. The collection will continue on an annual basis, providing a cumulative database and the opportunity for trend analysis.
Age Distribution↗
Information technology and health information management.
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Australia↗
DIStance-from-the PROtotype (DISPRO) personality assessment for children.
We examined a children's version of Broughton's (1990) DISPRO (DIStance-From-the-PROtotype), a multidimensional scaling approach to personality assessment. In this system, a score on a given trait dimension is derived from a subject's judgment about his or her similarity to or distance from a prototype - a hypothetical character who acts in trait-consistent or prototypical ways. The DISPRO assessment model employs eight equidistant trait categories from Wiggins's (1979) interpersonal circumplex. In this study, 74 children (M age = 7.3 years) were told stories about four same-sex characters who performed prototypical acts from a single trait category randomly selected from the circumplex. Results show the structure of children's ratings is remarkably similar to that obtained from adults, but children's ratings show a developmental trend. A sample of younger children (M age = 6) provided a unidimensional solution along a "good-bad" or nurturance continuum. Analysis of an older sample (M age = 8.5) revealed use of the two dimensions of dominance and nurturance commonly found in adult solutions. Significant validity coefficients for parent and teacher criterion measures (average r = .40) and adequate test-retest reliability (average r(tt)= .78) were found. Benefits unique to DISPRO, such as its ease of use and standardization of trait stimuli, are discussed.
Journal Article↗
A quality partnership: closing the gaps between hospital and the community.
Queensland Health is trialling an integrated package of projects aimed at reducing lengths of stay in public hospitals, providing continuity and quality of care from admission to an acute-care facility through to the completion of the episode in the community. Service gaps and reasons for delayed discharge are identified; funds are provided for the purchase of care for individual patients/clients; and the interface between hospital and community is co-ordinated. Multi-disciplinary teams, including the patient's own general practitioner, co-operate in the referral process for the provision of care within the community. Clinical nurse consultants monitor quality aspects from the community perspective. Implementation has been approached in different ways, at different sites. Education of key players is an important variable in the success of the project.
Aftercare↗
Binge eating disorder: its further validation in a multisite study.
Binge eating disorder (BED) is a new eating disorder that describes the eating disturbance of a large number of individuals who suffer from recurrent binge eating but who do not regularly engage in the compensatory behaviors to avoid weight gain seen in bulimia nervosa. This multisite study of BED involved 1,785 subjects drawn from 18 weight control programs, 942 subjects from five nonpatient community samples, and 75 patients with bulimia nervosa. Approximately 29% of subjects in weight control programs met the criteria for BED. In the nonpatient community samples BED was more common than purging bulimia nervosa. The validity of BED was supported by its strong association with (1) impairment in work and social functioning, (2) overconcern with body/shape and weight, (3) general psychopathology, (4) significant amount of time in adult life on diets, (5) a history of depression, alcohol/drug abuse, and treatment for emotional problems.
Adolescent↗
Binge eating disorder should be included in DSM-IV: a reply to Fairburn et al.'s "the classification of recurrent overeating: the binge eating disorder proposal".
Extensive recent research supports a proposal that a new eating disorder, binge eating disorder (BED), be included in DSM-IV. BED criteria define a relatively pure group of individuals who are distressed by recurrent binge eating who do not exhibit the compensatory features of bulimia nervosa. This large number of patients currently can only be diagnosed as eating disorder not otherwise specified (EDNOS). Recognizing this new disorder will help stimulate research and clinical programs for these patients. Fairburn et al.'s critique of BED fails to acknowledge the large body of knowledge that indicates that BED represents a distinct and definable subgroup of eating disordered patients and that the diagnosis provides useful information about psychopathology, prognosis, and outcome (Fairburn, Welch, & Hay [in press]. The classification of recurrent overeating: The "binge eating disorder" proposal. International Journal of Eating Disorders.) Against any reasonable standard for adding a new diagnosis to DSM-IV, BED meets the test.
Anorexia Nervosa↗
Risk factors for exposure to arsenic at a hazardous waste site.
Communities surrounding the Rocky Mountain Arsenal (RMA), a Superfund site in Colorado, were studied in order to determine whether exposures to arsenic were greater among persons who resided there than among residents of a comparison area. A census was conducted in areas adjacent to the RMA and in a comparison area 12-15 miles distant. From a stratified random sample, 469 persons were interviewed and urine samples obtained. Arsenic was detected in urine from 43 (9.2%) of the 469 persons sampled at a detection limit of 10 ppb. Trace levels of arsenic (detectable, but non-quantifiable) were found in 184 (39.2%) of those persons sampled. Neither the frequency of detection, the arithmetic mean nor the geometric mean values for urine arsenic was found to be statistically different when persons living near the site were compared to persons from the more distant comparison area. Therefore, the data were pooled across the study areas to evaluate risk factors for exposure to arsenic in this population-based sample. Multivariate logistic regression analyses were conducted to evaluate the risk of arsenic exposure associated with variables included in the interviews while controlling for confounding. Pathways for exposure to arsenic were evaluated through analysis of residence history, occupation, hobbies, dietary habits, water supply, housing and activity patterns. Children of Hispanic origin or non-white race, children who drank less than three glasses of water daily, and children who spent more time outdoors had an increased risk of having > or = 10 ppb of arsenic in their urine. Among adults, younger persons, especially those less than 40 years of age, persons of Hispanic origin or nonwhite race, and those employed in occupations where arsenic is likely to be found had an increased risk of having > or = 10 ppb of urine arsenic. Consumption of red wine or fish during the week prior to sampling was associated with trace levels of arsenic in urine.
Adolescent↗
Defective guanyl nucleotide-binding protein beta gamma subunits in a forskolin-resistant mutant of the Y1 adrenocortical cell line.
Forskolin-resistant mutants derived from Y1 adrenocortical cells display decreased responsiveness both to receptor and postreceptor stimulators of adenylyl cyclase and decreased amounts of the alpha subunits of the GTP-binding proteins (G proteins) that mediate stimulation (Gs) and inhibition (Gi) of adenylyl cyclase--namely, Gs alpha and Gi alpha-2. This phenotype is suggestive of a mutation that affects the processing or plasma membrane incorporation of G protein alpha subunits. Since the membrane attachment of heterotrimeric G proteins has been ascribed in part to the beta gamma subunits, we examined the quantity and functional activity of beta gamma subunits in wild-type Y1 and forskolin-resistant Forsk-10r-9 and Forsk-10r-3 cells. We now show that two assays previously used to examine the activity of purified beta gamma subunits--namely, to support either rhodopsin-catalyzed guanyl nucleotide exchange on Gt alpha or pertussis toxin-catalyzed ADP-ribosylation of Gt alpha--can be used with detergent extracts of cells. In both assays the beta gamma activity in Forsk-10r-9 and Forsk-10r-3 extracts was decreased by 53-76% compared with wild-type Y1 extracts. When normalized for immunoreactive beta subunit, the beta gamma activity in the Forsk-10r-9 samples was decreased by 55-57% compared with the wild-type Y1 samples. These results suggest that a mutation of one of the G protein beta or gamma subunits may result in the multiple defects of adenylyl cyclase activity and apparent loss of G protein alpha subunits seen in the forskolin-resistant mutant cells. The frequency with which these spontaneous mutations arise in the Y1 cell line suggests that they may contribute more generally to genetic abnormalities in signal transduction.
Adenosine Diphosphate Ribose↗