Letter: "Death with dignity".
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Attitude to Death↗
Biomedical subjects
K Meyers
Publications and source records attributed to K Meyers.
The development of the Comprehensive Addiction Severity Index for Adolescents (CASI-A). An interview for assessing multiple problems of adolescents.
The Comprehensive Addiction Severity Index for Adolescents (CASI-A) is a 45 to 90-minute comprehensive, semi-structured clinical interview for evaluating adolescents who present for treatment at various provider agencies. CASI-A modules and their individual items were selected and revised based on theory, clinical wisdom, and adolescent experiences obtained during pilot interviews and focus groups. The CASI-A assesses known risk factors, concomitant symptomatology, and consequences of adolescent alcohol/drug use within seven primary areas of functioning: education status, alcohol/drug use, family relationships, peer relationships, legal status, psychiatric distress, and use of free time. The CASI-A is not a diagnostic or screening instrument, but rather a clinical assessment tool that obtains clinically pertinent information designed to guide treatment planning and to evaluate treatment outcome. The CASI-A's design makes it suitable for administration in a variety of settings, for repeat administration at posttreatment follow-up evaluations, and for assessment of virtually all adolescents in treatment regardless of their admission problem. Overall, the CASI-A has encouraging but preliminary evidence of validity and internal consistency. Information collected soon after admission during administration of the CASI-A by nonclinical interviewers corresponded quite well with that obtained over the course of the adolescent's treatment stay by the entire treatment team. Revisions to the instrument are being made in those areas where correspondence between information on the CASI-A and that extracted from clinical records dropped below 75%, or in those early subscales, where alpha coefficients dropped below .6. As a result of the encouraging results reported in this paper, we are beginning additional psychometric testing, refining the proposed scoring system, and developing a computerized data entry, scoring, and report system.
Adolescent↗
HIV risks among homeless men differentiated by cocaine use and psychiatric distress.
This study examined the relationship among cocaine use, psychiatric distress, and HIV risk behaviors of homeless men. A 3 x 2 ANOVA was computed to determine overall mean HIV risk behavior, with the first factor representing three levels of psychiatric distress (low, moderate, and high) and the second factor representing use or no use of cocaine. Overall, homeless men who used cocaine had significantly higher HIV risk scores than did noncocaine users. Among the homeless men who used cocaine, those men who reported high psychiatric distress had significantly higher HIV risk scores than did noncocaine users and cocaine users with low psychiatric distress. Moreover, these risk scores predominantly represented three high risk sexual behaviors; lack of condom use, multiple sex partners, and participation in commercial sex. Outreach efforts that target both substance use and especially high-risk sexual practices are urged for this population.
Adult↗
Evaluation of canine-derived fibrin sealant as a hemostatic agent.
The purpose of this study was to determine whether canine-derived fibrinogen concentrate applied with bovine thrombin was a safe and effective topical hemostatic agent. A canine liver biopsy model was selected to test this product. Cryoprecipitate was prepared from frozen canine plasma using two freeze/thaw/centrifugation cycles. Six healthy adult dogs (weighing more than 18 kg) were used in the fibrin sealant study, and an additional three dogs were used as controls for the liver biopsy. A 1 x 3 cm liver biopsy specimen was obtained, digital pressure was applied to reduce bleeding, and the fibrinogen concentrate was immediately sprayed on the bleeding surface simultaneously with bovine thrombin (1,000 IU/mL). The mean +/- standard error of the mean (SEM) blood pressure at time of biopsy was 98 +/- 9 mm Hg, and the rate of hemorrhage from the cut liver edge was 8.0 +/- 1.1 mL/min. The total blood loss during fibrin sealant application was 37 +/- 9 mL and total time for hemostasis was 5.5 +/- 1.3 minutes. There was no additional hemorrhage after application of the fibrin sealant. In the three control dogs, fibrin sealant was not applied and only digital compression was used to decrease hemorrhage. Before digital compression, the rate of hemorrhage from the cut liver edge was 13.1 +/- 3.1 mL/min. Bleeding had not stopped after 10 minutes of compression and the mean postcompression rate of hemorrhage was 4.0 +/- 2.6 mL/min. Signs of secondary bleeding after fibrin sealant was applied were not evident during the immediate postoperative period or over the next 14 days.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Expression of tyrosine hydroxylase in an immortalized human fetal astrocyte cell line; in vitro characterization and engraftment into the rodent striatum.
The use of primary human fetal tissue in the treatment of neurodegenerative disorders, while promising, faces several difficult technical and ethical issues. An alternative approach that would obviate these problems would be to use immortalized cell lines of human fetal central nervous system origin. An immortalized human fetal astrocyte cell line (SVG) has been established (45) and herein we describe the in vitro and in vivo characteristics of this cell line which suggest that it may be a useful vehicle for neural transplantation. The SVG cell line is vimentin, GFAP, Thy 1.1 and MHC class I positive, and negative for neurofilament and neuron specific enolase, consistent with its glial origin. To determine whether the cell line could be used as a drug delivery system, a cDNA expression vector for tyrosine hydroxylase was constructed (phTH/Neo) and stably expressed in the SVG cells for over 18 months as demonstrated by immunohistochemistry and Western blotting of the stable transfectants. HPLC analysis of the supernatant from these cells, termed SVG-TH, consistently found 4-6 pmol/ml/min of l-dopa produced with the addition of BH4 to the media. Furthermore, in cocultivation experiments with hNT neurons, PC-12 cells and primary rat fetal mesencephalic tissue, both the SVG and SVG-TH cells demonstrated neurotrophic potential, suggesting that they constituitively express factors with neuroregenerative potential. To determine the viability of these cells in vivo, SVG-TH cells were grafted into the striatum of Sprague-Dawley rats and followed over time. A panel of antibodies was used to unequivocally differentiate the engrafted cells from the host parenchyma, including antibodies to: SV40 large T antigen (expressed in the SVG-TH cells), human and rat MHC class 1, vimentin, GFAP, and tyrosine hydroxylase. While the graft was easily identified with the first week, over the course of a four week period of time the engrafted cells decreased in number. Concomittantly, rat CD4 and CD8 expression in the vicinity of the graft increased, consistent with xenograft rejection. When the SVG-TH cells were grafted to the lesioned striatum of a 6-hydroxydopamine lesioned rats, rotational behavior of the rat decreased as much as 80% initially, then slowly returned to baseline over the next four weeks, parallelling graft rejection. Thus, the SVG-TH cells can induce a functional recovery in an animal model of Parkinson's disease, however as a xenograft, the SVG cells are recognized by the immune system.
Animals↗