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Biomedical subjects

J Randall

Publications and source records attributed to J Randall.

At least 37 records · Page 2Linked to original sources
PubMed1997

Investigating family-based alternatives to institution-based mental health services for youth: lessons learned from the pilot study of a randomized field trial.

The development and validation of family-based alternatives to out-of-home placements for children is an important goal in the mental health services field. The rigorous evaluation of such alternatives, however, can be difficult to accomplish. The purpose of this article is to describe initial barriers experienced during the pilot study of a randomized trial, funded by the National Institute of Mental Health, conducted in a field setting, and the strategies that were used to overcome these barriers. The randomized trial is examining home-based multisystemic therapy as an alternative to the psychiatric hospitalization of youths presenting psychiatric emergencies. The pilot study illuminated the interface of treatment and services research issues, prompting significant changes in the project's clinical procedures, organization, and supervisory processes, as well as in the project's interface with existing community resources for serving youths with serious emotional disturbances.

Adolescent↗
PubMed1997

Generalized covariance-adjusted discriminants: perspective and application.

When discriminant analysis is used in practice for assessing the usefulness of diagnostic markers, the lack of control over covariates motivates the need for their adjustment in the analysis. This necessity for adjustment arises especially when the researcher's aim is classification based on a set of diagnostic markers and is not based on a set of covariates for which there exists known heterogeneity among the subjects with respect to the groups under consideration. The traditional covariance-adjusted approach is restrictive for such applications in that they assume linear covariates and a normal distribution for the the feature vector. Further, there is no available method for variable selection in using such covariance-adjusted models. In this paper, we generalize the traditional covariance-adjusted model to a general normal and logistic model, where these generalized models not only relax the distributional assumptions on the feature vector but also allow for nonlinear covariates. Exact and asymptotic tests are also derived for the problem of variable selection for these new models. The methodology is illustrated with both simulated data and an actual data set from a psychiatric study on using the Social Rhythm Metric for patients with anxiety disorders.

Activities of Daily Living↗
PubMed1996

Osmotic stress protein 94 (Osp94). A new member of the Hsp110/SSE gene subfamily.

Preservation of cell viability and function in the hyperosmolar environment of the renal medulla is a complex process that requires selective gene expression. We have identified a new member of the heat shock protein (hsp) 70 superfamily that is up-regulated in renal inner medullary collecting duct cells (mIMCD3 cells) during exposure to hyperosmotic NaCl stress. Known as osmotic stress protein 94, or Osp94, this 2935-base pair cDNA encodes an 838-amino acid protein that shows greatest homology to the recently discovered hsp110/SSE gene subfamily. Like the hsps, Osp94 has a putative amino-terminal ATP-binding domain and a putative carboxyl-terminal peptide-binding domain. The in vitro translated Osp94 product migrated as a 105-110-kDa protein on SDS-polyacrylamide gel electrophoresis. In mIMCD3 cells, Osp94 mRNA expression was greatly up-regulated by hyperosmotic NaCl or heat stress. In mouse kidney, Osp94 mRNA expression paralleled the known corticomedullary osmolality gradient showing highest expression in the inner medulla. Moreover, inner medullary Osp94 expression was increased during water restriction when osmolality is known to increase. Thus, Osp94 is a new member of the hsp110/SSE stress protein subfamily and likely acts as a molecular chaperone.

Amino Acid Sequence↗
PubMed1996

Transcriptional responses to tubule challenges.

Adaptation to physiological stimuli often involves changes in gene transcription. Studies of hyperosmolar stress in renal epithelial cells have provided an ideal paradigm for understanding regulation of gene expression. Renal epithelial cells respond very differently to hyperosmolar NaCl and urea and several strategies including cloning based on known biological function, candidate gene analysis, and differential display analysis have successfully identified many genes induced by these hyperosmolar challenges. Hyperosmolar NaCl produces adverse effects on cellular biosynthetic processes and compensatory increases are observed in transcription of transporters, stress proteins, and metabolic enzymes. In contrast, hyperosmolar urea fails to inhibit biosynthetic processes but, nonetheless, initiates a very specific program of gene expression in renal epithelial cells. This program appears to involve a urea sensor/receptor system which activates transcription and translation of the zinc-finger transcription factor Egr-1. This work highlights the concept that rapid analysis of differential gene expression will enable one to define cellular programs of gene expression involving up- and down-regulation of functionally-related gene families.

Animals↗
PubMed1994

Social rhythm in anxiety disorder patients.

UNLABELLED: The social rhythm metric (SRM) is a self report diary instrument which generates a numerical measure of rhythmicity of daily life behaviors. Depression researchers have proposed that life events cause disruption of social rhythmicity and this leads to disturbance in the sense of well-being and to disruption of physiologic rhythmicity known to be related to depressive episodes. We hypothesized that low rhythmicity of daily activities might also be characteristic of anxiety disorder patients. SUBJECTS: Forty-eight patients who met DSM III-R criteria for an anxiety disorder were recruited and compared with 41 previously monitored normal controls. PROCEDURES: All patients and controls completed at least two weeks of daily monitoring with the SRM. Anxiety patients underwent structured diagnostic assessment and completed demographic and clinical rating scales. SRM was analyzed according to a previously developed algorithm. RESULTS: Anxiety disorder patients report significantly lower regularity of daily activities than normal controls. The low SRM scores were not accounted for by the presence of comorbid affective disorder. CONCLUSIONS: We identify a new type of abnormality in anxiety disorder patients which has potential clinical as well as theoretical interest.

Activities of Daily Living↗
PubMed1992

Prospective study of short and long regimens of gonadotropin-releasing hormone agonist in in vitro fertilization program.

OBJECTIVE: To assess the usefulness of a short regimen in ovulation induction in an in vitro fertilization (IVF) program. DESIGN: A prospective randomized trial was set up to compare long and short regimens of gonadotropin-releasing hormone agonist administration for ovulation induction in IVF. SETTING: Aberdeen Assisted Reproduction Unit. PATIENTS: Eighty-seven patients undergoing IVF were randomized between the two protocols. Stimulation regimen was the only variable being tested. MAIN OUTCOME MEASURES: Stimulation response and occurrence of luteinizing hormone (LH) surges. RESULTS: There was no difference in the stimulation requirements, response to stimulation, number of follicles aspirated, or the number of oocytes obtained. The fertilization rates, number of embryos transferred, and pregnancy rates were also similar in both groups. Like the long regimen, it prevents the occurrence of a premature LH surge. CONCLUSION: The short regimen is a useful and cheaper alternative in ovarian stimulation of patients undergoing IVF.

Adult↗
PubMed1991

Use of emergency services by unaccompanied minors.

STUDY OBJECTIVE: The objective of the study was to describe the use of emergency services by minors who are unaccompanied by their parents or guardians and how they are managed in emergency departments. DESIGN: Self-administered survey. TYPE OF PARTICIPANTS: The ED directors of 71 emergency medicine training programs, 82 Michigan community EDs, and 56 pediatric EDs. MEASUREMENTS AND MAIN RESULTS: One hundred eighteen (58%) surveys were returned. A median of five unaccompanied minors (range 0.2 to 150) were seen weekly by responding EDs. Pediatric EDs saw the most unaccompanied minors weekly (ten) compared with training programs (five) and community EDs (three) (P less than .01). Emergency medicine training programs had the greatest percentage (3.0%) of minors who were unaccompanied compared with pediatric EDs (2.2%) and community EDs (2.6%) (P less than .05). For all conditions surveyed, only 3.8% of patients would be refused medical care without parental consent. However, 36.8% of patients would have medical care delayed even for conditions that might be painful or harmful if left untreated for some time. Most EDs (85.5%) screen patients and treat those who are acutely ill, but some (11.1%) treat all regardless of severity. CONCLUSION: Protocols should be developed for unaccompanied minors to ensure that delays in obtaining consent do not jeopardize the child and that the rights of minors for confidentiality and consent are recognized.

Adolescent↗
PubMed1991

Xanthine oxidase is not a major source of free radicals in focal cerebral ischemia.

Xanthine oxidase (XO) has been proposed as an important source of free radicals during ischemia. This enzyme normally exists as a dehydrogenase (XD), but it is converted to XO in some ischemic tissues. Recently, treatment of animals with the XD and XO inhibitor allopurinol or with free radical scavengers before cerebral ischemia has been shown to reduce brain injury. Therefore, we studied conversion of XD to XO in three ischemic and nonischemic brain regions during focal cerebral ischemia resulting from permanent occlusion of the middle cerebral artery (MCAO) in anesthetized rats. In nonischemic brain, 16-22% of the enzyme was in the XO form. After 24 h of ischemia this value was not significantly different (10-15%). Neither the total activity of XO nor that of XD changed, indicating that there was no irreversible conversion of XD to XO. To further explore the possible role of XO, we examined the effect of various doses of allopurinol (5, 20, or 100 mg/kg given 1 h before MCAO or 100 mg/kg given 48, 24, and 1 h before MCAO) on uric acid accumulation, brain edema formation, and cerebral blood flow (CBF) 24 h after MCAO. All but the lowest dose of allopurinol greatly reduced the appearance of uric acid in the ischemic brain; however, only the highest dose of allopurinol had any beneficial effect on brain edema. This reduction in brain edema occurred without a significant improvement in CBF. Thus XO is probably not an important source of free radicals in this model of focal cerebral ischemia.

Allopurinol↗
PubMed1990

A primary preventive approach to children's drug refusal behavior: the impact of rehearsal-plus.

The effectiveness of a short-term prevention program to increase drug refusal behavior in a school-age population was assessed. Forty-two third-grade children were randomly assigned to one of three groups: rehearsal-plus, traditional, or attention control. Children in the rehearsal-plus group were taught specific drug refusal techniques and appropriate social skills, and were provided a rationale for each response. This procedure included behavioral training and elaborative rehearsal. Training occurred in four socially validated situations corresponding to settings where children were likely to be offered drugs. The traditional procedure consisted of instructions derived from a "Just Say No" drug program. Assessment focused on specific refusal behaviors, procedural knowledge, and self-efficacy. Significant gains in desired functioning and appropriate behavioral and social skills were found. The effectiveness of the rehearsal-plus procedure as a method of increasing adaptive responding in dangerous and/or anxiety-arousing situations is discussed.

Behavior Therapy↗
PubMed1989

The frequency of chromosome anomalies in human preimplantation embryos after in-vitro fertilization.

Previous studies have reported chromosome aberrations in human pre-embryos after in-vitro fertilization (IVF). Although the reason for these abnormalities is not clear, there is evidence that they can arise during gametogenesis, fertilization or cleavage. The present study has examined further the incidence of chromosome abnormalities in human pre-embryos after IVF, using oocytes recovered from normal volunteer women and from women undergoing infertility treatment in an embryo-replacement programme. Chromosome preparations were performed for 75 pre-embryos. Of these 35 (47%) gave at least one metaphase in which analysis was possible. The overall incidence of abnormal pre-embryos was 40% (14/35). The absolute frequency of aberrations was 9% for trisomies, 3% for polyploidies, 26% for structural anomalies and 3% for hypodiploidies. Five pre-embryos were found to be mosaics, three of which had each one trisomic metaphase. In five of the pre-embryos multiple anomalies were found. In 13 of the 14 abnormal pre-embryos the aberrations were found in only one metaphase. The present study demonstrates that trisomic mosaicism may not be a rare event in human pre-embryos. Further evidence is provided that mitotic non-disjunction is important for the production of aberrations in human pre-embryos.

Blastocyst↗
PubMed1989

The frequency of chromosome anomalies in human unfertilized oocytes and uncleaved zygotes after insemination in vitro.

Data on first trimester human abortions have shown chromosome aberrations in approximately 50% of the cases, most of which were trisomies. More than 80% of these trisomies have been attributed to an error in the oocyte. In this study we investigated the frequency of chromosome anomalies in 44 human unfertilized oocytes and 13 uncleaved zygotes after insemination in vitro. The oocytes were aspirated from preovulatory follicles in parous volunteer donors and patients participating in an embryo replacement programme. Thirty cases could be analysed, 18 of which (60%) carried a chromosome abnormality. There were two hyperhaploidies (6.7%), four hypohaploidies (13.3%), three polyploidies (10%), six with structural aberrations (20%) and five diploidies (16.7%). The incidence of these abnormalities, except for the structural anomalies, was similar to that reported previously. The higher frequency of structural aberrations in the present study may be related to delayed cytogenetic analysis for up to 48 h after insemination.

Abortion, Spontaneous↗
PubMed1988

Installation and use of a neodymium-YAG laser in a urology department.

We report our experience in setting up a urological laser unit. An operating theatre was upgraded to include the required safety features and a neodymium-YAG laser was installed. A preliminary study using cadaver bladders was performed to establish the technique of cystoscopic laser application. We treated 55 bladder tumours in 12 patients by laser coagulation, with total destruction of 54 tumours and no serious complications; 6 patients developed recurrent tumours. Twenty-one patients underwent surgery with the contact laser scalpel. The instrument proved slow but effective, with excellent haemostasis and almost painless wounds. Healing was delayed in 2 cases but there were no wound infections. All wounds healed with good cosmetic scars. The neodymium-YAG laser is an effective means of destroying superficial non-invasive bladder tumours endoscopically and can also be used in conjunction with a laser scalpel for open surgery.

Aged↗
PubMed1987

Ureteropyelostomy: a simple and effective treatment for symptomatic ureteroureteric reflux.

Partial ureteric duplication may cause delayed drainage of urine from the upper tracts because of ureteroureteric "see-saw" reflux. This can be eliminated by the procedure of ureteropyelostomy, in which the partially duplicated ureter is converted into a bifid renal pelvis. This operation leaves a short anastomotic suture line and has a low complication rate. We report seven patients who have undergone ureteropyelostomy for symptomatic ureteroureteric reflux. All remain symptom-free after follow-up for a minimum of 1 year.

Anastomosis, Surgical↗