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Biomedical subjects

J Shapiro

Publications and source records attributed to J Shapiro.

At least 127 records · Page 7Linked to original sources
PubMed1993

Radioactive waste management at a large university and medical research complex.

A radioactive waste management program was developed for a large university and medical research complex to contain costs and to reduce the impact of the Low-Level Radioactive Waste Policy Act. The program takes advantage of decay-in-storage, incineration, special packaging techniques, and increased training and awareness. A series of metrics are presented to evaluate the effectiveness of the radioactive waste management program. Through the use of this program the amount of waste disposed of at commercial burial sites decreased from 98% to 1.61% of the waste generated. At the same time the volume of waste generated per laboratory declined by almost 45%, from 0.35 m3 (12.31 ft3) to 0.19 m3 (6.80 ft3).

Academic Medical Centers↗
PubMed1993

HIV risk among women injecting drug users who are in jail.

Female offender populations and females in jail include large proportions of injecting drug users (IDUs), who are at high risk of contracting or transmitting HIV. Women IDUs (n = 165) were recruited and interviewed at New York City's central jail facility for women. The study examined these women's patterns of HIV risk behaviors related to drugs and sex and identified behavioral and attitudinal correlates of HIV serostatus. The women typically used both injectable and non-injectable drugs prior to arrest, primarily heroin, cocaine powder, crack, and illicit methadone. Self-reported HIV seropositivity was 43%. Variables correlated with HIV serostatus in the bivariate analysis were: cocaine injection frequency; lifetime injection risk behavior; providing oral sex during male crack use; Hispanic ethnicity; sharing of needles/syringes; sharing of cookers; sharing injection equipment with friends; heroin smoking (negative); injection risk acceptance; peer norms and behavior; lifetime sexual risk behavior; frequency of sex with men; provision of sex for money or drugs; and knowing people with AIDS. The first four variables listed retained statistical significance in a multiple logistic regression analysis. The paper considers the need to tailor AIDS prevention interventions for woman IDUs in jail, including taking into account risk behaviors that occur within frequently reported same-sex partnerships.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The pivotal role of 5-lipoxygenase products in the reaction of aspirin-sensitive asthmatics to aspirin.

A subset of persons with asthma develop bronchospasm, naso-ocular, gastrointestinal, and/or dermal reactions after ingesting aspirin (ASA) or agents with the capacity to inhibit cyclooxygenase. The bronchopulmonary reactions have been associated with a rise in urinary LTE4. We examined the effects of an inhibitor of 5-lipoxygenase, zileuton, in a group of eight asthmatic patients with known sensitivity to ASA accompanied by LTE4 hyperexcretion. We first confirmed ASA sensitivity and an increase in urinary LTE4 after ASA ingestion in these patients using a placebo-controlled ASA challenge. Subjects were then randomized to a double-blind, crossover trial to examine the effects of zileuton versus placebo on the response to ASA. Zileuton treatment decreased baseline urinary LTE4 excretion from a mean of 469 +/- 141 pg/mg creatinine to 137 +/- 69 pg/mg creatinine (p < 0.02) and blunted the maximum increase in urinary LTE4 after ingestion of ASA (3,539 +/- 826 pg/mg creatinine versus 1,120 +/- 316 pg/mg creatinine [p < 0.01]). The pre-ASA challenge FEV1 was unchanged by zileuton (3.41 +/- 0.15 L versus 3.35 +/- 0.17 L, zileuton versus placebo). Zileuton prevented the fall in FEV1 in response to ingestion of ASA; post-ASA ingestion the mean of the minimal FEV1 fell to 2.72 +/- 0.18 L on the placebo day while there was no significant fall on the zileuton day (3.26 +/- 0.17 L; p < 0.014). Zileuton also prevented the development of the nasal, gastrointestinal (p < 0.006 and p < 0.025, respectively), and dermal symptoms which developed after ASA ingestion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Congenital vertebral displacement.

We defined congenital vertebral displacement as displacement at a single vertebral level that results in an abrupt displacement of the neural canal. We reviewed the data on 642 patients who had congenital vertebral abnormalities and identified ten who had congenital vertebral displacement. There were two patterns of deformity: Type A (eight patients) consisted of displacement in the sagittal plane only, and Type B (two patients), rotatory, transverse, and sagittal displacement. The spinal deformity was usually noted in infancy. Neurological deficits were identified at the time of presentation or developed later in six patients. Two patients had a sudden onset of paraplegia after slight trauma, two had a gradual onset of neurological abnormalities, and two had neurological abnormalities when they were first seen. Three patients had congenital anomalies of the spinal cord. We found marked mechanical instability intraoperatively in five patients, and we believe that the instability in combination with compression of the spinal cord resulted in myelopathy. We recommend combined anterior and posterior arthrodesis of the spine for the treatment of this disorder. We believe that decompression of the spinal cord is indicated for patients who have a neurological deficit of recent onset or a progressive neurological deficit. Decompression of the spinal cord may also be indicated for the treatment of long-standing deficits after spinal stability has been obtained.

Abnormalities, Multiple↗
PubMed1993

A comparison of conventional dialytic therapy and acute continuous hemodiafiltration in the management of acute renal failure in the critically ill.

OBJECTIVE: To compare and contrast the clinical outcomes in critically ill patients with acute renal failure managed with either acute continuous hemodiafiltration or conventional dialytic therapies. DESIGN: Retrospective review of the medical records of 167 consecutive cases of acute renal failure treated at a single center (July 1982-July 1991). Scoring for illness severity (APACHE II, number of failing organs) and assessment of outcome in terms of biochemical control of azotemia, ARF therapy-related morbidity, and overall morbidity and mortality. SETTING: Tertiary institution. PATIENTS: 167 consecutive critically ill patients with multiorgan failure and acute renal failure. MEASUREMENTS AND MAIN RESULTS: 84 patients received conventional dialytic therapy (CDT) (1982-1988) and 83 acute continuous hemodiafiltration (ACHD) (1988-1991). The etiology of ARF and illness severity indices were similar in both groups (organ failure scores: CDT 3.9 vs. ACHD 4.1; NS). All patients were critically ill, with more severely ill patients within the ACHD groups (mean APACHE II score: CDT 25.8 vs. ACHD 28.1; p < .01). There were no significant differences in pretreatment serum creatinine, glucose, bicarbonate and phosphate, white cell and platelet counts, incidence of disseminated intravascular coagulation, prevalence of sepsis, or evidence of pulmonary and/or peripheral edema. Overall survival was 29.8% for the CDT groups and 41% for the ACHD group (NS). When patients were stratified by severity of illness, survival in those with 2 to 4 failing organs was significantly greater in the ACHD group (CDT 31.1% vs. ACHD 53.8%; p < .025). Similarly, overall survival in patients with intermediate APACHE II scores (24 to 29) was significantly better in those treated with ACHD (CDT 12.5% vs. ACHD 46.4%; p < .025). During the course of ARF, in comparison to CDT, ACHD was associated with greater overall reductions in serum creatinine, and in phosphate and plasma urea, and an increased net nutritional intake. CONCLUSIONS: ACHD provided biochemical and outcome indicator advantages over conventional dialytic therapy. In patients with 2 to 4 failing organs or an intermediate APACHE II score (24 to 29) a significant survival advantage was demonstrated for ACHD over CDT. Although this study is a retrospective analysis, with all the inherent limitations of such studies, it suggests that ACHD is the treatment of choice for ARF in the critically ill, with maximum benefits seen in those with 2 to 4 failing organs and/or intermediate APACHE II scores.

Acute Kidney Injury↗
PubMed1993

Psychosocial performance of family physicians.

This study surveyed 30 residency-trained family physicians all currently in practice to determine the nature of their psychosocial interactions with patients. In general, respondents were satisfied with the quality of their psychosocial training in residency and generally evaluated their competency on a range of psychosocial skills as adequate to excellent. Physician psychosocial competency was most strongly related to residency, but not to postresidency, behavioral science training or to psychosocial screening practices. Frequency of performing psychosocial behaviors was also related to behavioral science training, as well as to length of time in practice. Neither frequency nor self-perceived competency related to physician age, gender, patient volume, or type of practice.

Adult↗
PubMed1993

Topical immunotherapy in the treatment of chronic severe alopecia areata.

In the past decade, topical immunotherapy with DPCP has been shown to be a very important therapeutic modality in the treatment of chronic severe alopecia areata. At the University of British Columbia Hair Clinic, it is our treatment of choice in adults. This option for treatment should be offered to the appropriate patients.

Administration, Topical↗
PubMed1993

Alopecia areata. Update on therapy.

The treatment of alopecia areata has changed markedly in the past decade. Several options are now available to the patient. It is the dermatologist's duty to inform the patient of all the options, their side effects, and their success rates. The final selection of treatment is a team decision between the patient, the patient's family, and the physician.

Administration, Cutaneous↗
PubMed1992

Vitamin D and osteocalcin levels in liver transplant recipients. Is osteocalcin a reliable marker of bone turnover in such cases?

Patients with advanced liver disease are at increased risk for the development of hepatic osteodystrophy in the form of either osteomalacia or osteoporosis. The pathogenesis of these two bone diseases is multifactorial and includes, among other factors, alterations in vitamin D metabolism, malnutrition and hypogonadism. Little is known regarding vitamin D metabolism and the osteoblastic activity in liver transplant recipients. In order to clarify these issues, vitamin D metabolites and osteocalcin levels were measured prior to and 30 days following liver transplantation in 30 cirrhotic patients of various etiologies. While the mean plasma concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D of the entire group of 30 patients were significantly greater prior to orthotopic liver transplantation (OLTx) as compared to those after OLTx (11.5 +/- 8.6 vs. 7.4 +/- 5.8 ng/ml, p = 0.0066 and 41.0 +/- 34.6 vs. 20.4 +/- 11.0 pg/ml, p = 0.0003, respectively), no significant changes in osteocalcin concentrations pre- or post-transplantation could be demonstrated (5.2 +/- 3.0 vs. 6.4 +/- 4.1 ng/ml, p = 0.51). Furthermore, no correlation between the plasma concentration of osteocalcin and either vitamin D metabolite, the prothrombin time or cyclosporine levels was found. The reasons for the normal levels of osteocalcin prior to OLTx can be explained by the fact that in vitamin-K-deficient states osteocalcin is predominantly decarboxylated and, therefore, a smaller proportion is bound to bone and/or the synthesis of osteocalcin is partially modulated by 1,25-dihydroxyvitamin D, the level of which has been found to be normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Goals and methods of research: the challenge for family medicine.

This article suggests that motivations to engage in research, as in any other human activity, are both explicit and implicit. Explicit motivations tend to be objective and rationalist, concerned with such goals as the advancement and organization of knowledge. But implicit motivations, the 'hidden agendas' of research, also exist and can influence the objectives, methods, and conclusions of the research process. In addition, a highly affectively charged activity such as research also develops its own set of symbolic meanings, which further complicate its various expressions. In this article, three such symbolic meanings are identified: purpose and seriousness; maturity and adulthood; and legitimacy and belonging. The article highlights qualitative research as a methodology compatible with much of family medicine's philosophy and theoretical foundations; and discusses the role of behavioural scientists in participating in a research agenda for the field. The article concludes with a plea for the discipline of family medicine to opt for authenticity in research, rather than settling for a superficial legitimacy in the eyes of other medical specialties.

Family Practice↗
PubMed1992

A descriptive analysis of health insurance coverage among farm families in Minnesota.

This paper reports the findings of a study of health insurance coverage and access to health services among farm families in Minnesota. The study included 1,482 families actively engaged in farming during 1989. While less than 10 percent of the population were uninsured during this period, the majority had limited coverage with high deductible and coinsurance provisions. Moreover, they were paying an estimated 15 to 20 percent more for their plans than a similar plan would have cost in the Minneapolis-St. Paul, MN, area. With the exception of cost, satisfaction with health services was found to be very high, and there were few indications of access problems.

Agriculture↗
PubMed1992

Glucose utilization in a patient with hepatoma and hypoglycemia. Assessment by a positron emission tomography.

Tumor glucose use in patients with non-islet-cell tumors has been difficult to measure, particularly in hepatoma, because of hepatic involvement by neoplasm. We studied a patient with nonhepatic recurrence of hepatoma after successful liver transplantation. Tumor tissue contained messenger RNA for insulin-like growth factor-II (IGF-II), and circulating high molecular weight components and E-peptide of IGF-II were increased. Glucose use measured by isotope dilution with [3-3H]glucose was 7.94 mg/kg fat-free mass per min, and splanchnic glucose production was 0.93 mg/kg fat-free mass per min. Glucose uptake and glucose model parameters were independently measured in tissues by positron emission tomography with 18F-fluoro-2-deoxy-D-glucose. Glucose uptake by heart muscle, liver, skeletal muscle, and neoplasm accounted for 0.8, 14, 44, and 15% of total glucose use, respectively. Model parameters in liver and neoplasm were not significantly different, and glucose transport and phosphorylation were twofold and fourfold greater than in muscle. This suggests that circulating IGF-II-like proteins are partial insulin agonists, and that hypoglycemia in hepatoma with IGF-II production is predominantly due to glucose uptake by skeletal muscle and suppression of glucose production.

Adult↗
PubMed1992

Health of retired workers: survival status and Medicare service use.

Data from the Social Security Administration's 1982 New Beneficiary Survey and Master Beneficiary Record were matched with 1984 data from the Medicare Automated Data Retrieval System to study the effects of self-reported health on subsequent health service usage and survival. Proportionately, more new retired workers who reported poorer health in 1982 were decreased by December 1984. Functionally dependent beneficiaries as determined by the Functional Capacity Limitation Index had death rates four to five times greater than those who reported no limitations. The health status of retired workers who received Social Security benefits before age 65 was no better than beneficiaries 65 or over. Decedents were more likely than survivors to incur Medicare charges, and to have substantially higher median charges--$8,834 compared with $285.

Age Factors↗
PubMed1991

Resident psychosocial performance: a brief report.

This study investigated the psychosocial skills of 55 family practice residents conducting patient interviews in actual clinical settings. Results indicated that resident performance was at least adequate, demonstrating competence in basic interpersonal and medical interviewing skills on the majority of categories rated. However, residents performed less well in areas of greater psychosocial complexity, in particular in addressing the meaning or implications of illness with patients and families. Sex differences between male and female residents were also explored and in general found to be nonsignificant, although women residents tended to perform somewhat better in terms of empathy, open-ended questions, and reassurance.

Clinical Competence↗