A bougie for a 2.5mm tracheal tube.
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Angiography↗
Biomedical subjects
K Reynolds
Publications and source records attributed to K Reynolds.
Measuring self-efficacy in substance abuse intervention in obstetric practices.
BACKGROUND: This study presents findings on the effect of an office-based obstetrics training program (given the acronym OBIWOM) on substance use assessment, management, and referral self-efficacy among obstetricians and staff of private, community-based obstetric practices. METHODS: Participants were obstetricians and staff from 10 of 27 available community-based, private obstetric practices in the target areas, for a practice participation rate of 37%. This study used a delayed treatment design to compare self-efficacy between practice staff randomly assigned to an immediate or delayed intervention group. RESULTS: Self-efficacy increased significantly after intervention from baseline to first follow-up for the immediate group, while no change was shown for the delayed (control) group. The impact of the intervention on self-efficacy was replicated in the assessment construct only after the intervention for the delayed group. CONCLUSION: This research shows that education and training can effectively improve self-efficacy in obstetricians and their staff in the management of substance use and pregnancy.
Adult↗
Unraveling the realities of vascular access: the Network 11 experience.
Arteriovenous (AV) fistulae are well recognized as the preferred vascular access for hemodialysis, yet national data show that only 23% of patients used an AV fistula in 1997. To identify barriers to the placement of native AV fistulae, the Renal Network of the Upper Midwest, Inc. (End-Stage Renal Disease [ESRD] Network 11) initiated a vascular access project to look at the process of referral for patients beginning hemodialysis in the first 6 months of 1999. Of these patients, 63% began hemodialysis with a catheter as the only access, 22% had an AV fistula placed (but only 14% used an AV fistula for their first dialysis treatment), and 15% began with a graft. About 40% of patients were referred to a nephrologist less than 1 month before dialysis, allowing little chance for permanent access placement. Yet 27% of patients used a catheter on the first hemodialysis treatment and were seen by a nephrologist more than 1 month before starting dialysis, indicating the presence of an opportunity to improve. At 6 months after initiation of dialysis, 25% of patients who began dialysis using a catheter were using an AV fistula and 35% were using a graft. Network 11 plans to use this information to promote early referral of patients to a nephrologist and subsequent prompt referral of such patients to a vascular surgeon. Other activities to improve vascular access management are also indicated.
Adolescent↗
Injuries and risk factors in an 18-day Marine winter mountain training exercise.
OBJECTIVES: This study determined the incidence of and risk factors for injuries among 356 Marines during a winter mountain training exercise. METHODS: Marines received a podiatry screening and completed a questionnaire on race, education, tobacco use, height, weight, and fitness (4.8-km run, sit-ups, pull-ups). RESULTS: Forty-five Marines (12.6%) reported at least one injury each, 68.9% of which were traumatic injuries. Total injuries resulted in 114 days of limited duty time. A final foot examination (N = 141) revealed 118 injuries (82.2% blisters and abrasions, 11.9% frostnip). White ethnicity was a risk factor for overall injuries, and forefoot varus alignment was a risk factor for traumatic injuries. Lower education and rank and smokeless tobacco use were associated with foot injuries. The Marine ski-march leather boot and smoking were related to foot cold injuries. CONCLUSIONS: Military winter training is associated with injuries and lost training time. Risk factors were identified, suggesting that these injuries may be preventable.
Adult↗
Adequacy of prenatal care and prescription of zidovudine to prevent perinatal HIV transmission.
In 1994, data were published on the effectiveness of zidovudine in preventing perinatal transmission of HIV infection. Using data from surveillance projects in San Antonio, Dallas, and Houston, Texas, U.S.A., we linked records of children born from 1987 through 1996 with records of their HIV-infected mothers. Prenatal care was measured by Kotelchuck's Adequacy of Prenatal Care Utilization (APNCU) Index. We examined the association between adequacy of prenatal care and four measures of zidovudine prescription: prenatal, intrapartum, neonatal, and the complete regimen. Inclusion criteria was that the mother's HIV infection was diagnosed before a live birth; 221 mother-infant pairs were included in the analysis. Overall, 68% received inadequate or no prenatal care. Over time, the proportion of mother-infant pairs with adequate prenatal care doubled (24%-48%; relative risk [RR], 2.0; 95% confidence interval [CI], 1.3-3.0), and the proportion prescribed prenatal zidovudine tripled (20%-67%; RR, 3.4; 95% CI, 2.4-4.9). In logistic regression, APNCU (adjusted odds ratio [aOR], 2.6; 95% CI, 1.1-6.2) and time period (aOR, 19.9; 95% CI, 8.1-48.7) were associated with prenatal prescription of zidovudine. The benefits of prenatal care, including HIV testing and zidovudine treatment, underscore the urgent need to improve access to and use of prenatal care services.
Adult↗
Auditory preference for conspecific song in isolation-reared zebra finches.
Seven female and six male zebra finches, Taeniopygia guttata, were reared in acoustic isolation from song and tested for their preference for conspecific song when 28-53 days old by allowing them to select exposure to zebra finch or European starling, Sturnus vulgaris, song. The birds hopped more frequently on a perch that generated zebra finch song than one that produced starling song, and they spent more time listening to zebra finch song. There were no sex differences. The results indicate that during their sensitive period for song learning, and prior to experience with song, zebra finches prefer conspecific song to heterospecific song. Copyright 1999 The Association for the Study of Animal Behaviour.
Journal Article↗
Production of influenza-stimulated tumor necrosis factor-alpha by monocytes following acute influenza infection in humans.
Tumor necrosis factor-alpha (TNF-alpha) is often measured in the serum or plasma of patients with severe infections, and marked elevation correlates with poor outcome. The relationship of TNF-alpha to protection from disease is frequently not observed because prospective studies of infectious agents are difficult to perform. We took advantage of a human antiviral influenza challenge study to correlate TNF-alpha production with seroconversion and symptom development. TNF-alpha production was measured by ELISA in the plasma compartment or was measured by intracellular production at the single cell level in the monocyte gated population. Monocyte TNF-alpha was associated with asymptomatic seroconversion, whereas there was no change in the plasma at the times measured. Measurement of TNF-alpha at the single cell level by flow cytometry may allow for better differentiation of the protective role of this cytokine in future studies.
Adolescent↗
FDA evaluations using in vitro metabolism to predict and interpret in vivo metabolic drug-drug interactions: impact on labeling.
Recent advances in in vitro metabolism methods have led to an improved ability to predict clinically relevant metabolic drug-drug interactions. To address the relationships of in vitro metabolism data and in vivo metabolism outcomes, the Office of Clinical Pharmacology and Biopharmaceutics in the Center for Drug Evaluation and Research, Food and Drug Administration, evaluated a number of recently approved new drug applications. The goal of these evaluations was to determine the contribution of in vitro metabolism data in (1) predicting in vivo drug-drug interactions, (2) determining the need to conduct an in vivo drug-drug interaction study, and (3) incorporating findings into drug product labeling. Ten cases are presented in this article. They fall into two major groups: (1) in vitro data were predictive of in vivo results, and (2) in vitro data were not predictive of in vivo results. Discussion of these cases highlights factors limiting predictability of in vivo metabolic interactions from in vitro metabolism data. The integration of these findings into drug product labeling is also discussed.
Data Collection↗
Magnetic resonance imaging of actinomycosis presenting as pelvic malignancy.
Pelvic actinomycosis is associated with long-standing use of an intrauterine contraceptive device and may present with clinical signs and symptoms of pelvic malignancy. Diagnostic imaging can confirm the presence of a pelvic mass and tissue infiltration but findings are often non-specific. We present a case of pelvic actinomycosis with tubo-ovarian abscess in which magnetic resonance imaging demonstrated lower signal intensity tissue on T2 weighted sequences than would be typical for pelvic malignancy or infection and was useful in confirming regression of pelvic disease in response to antibiotic therapy.
Actinomycosis↗
Risk factors for foot blisters during road marching: tobacco use, ethnicity, foot type, previous illness, and other factors.
Three hundred thirty-nine freshmen participating in cadet basic training at the U.S. Military Academy completed a questionnaire that asked them about their previous military experience, gender, ethnicity, injuries and illness experienced in the last 12 months, foot type, cigarette smoking habits, smokeless tobacco use, alcohol consumption, and sleep habits. They then performed a 21-km road march in about 6.5 hours. Their feet were examined for blisters before and after the march. Univariate analysis showed that risk factors for foot blisters included ethnicity (blacks at lower risk than others), a sickness in the last 12 months, no previous active duty military experience, use of smokeless tobacco, and flat feet (pes planus). Logistic regression indicated that all of these were independent blister risk factors with the exception of no previous active duty military experience.
Analysis of Variance↗
A pilot study of the efficacy and tolerability of intralesional recombinant human beta-interferons in cervical intraepithelial neoplasia.
Beta-interferons possess anti-viral, cell proliferation inhibition and immunomodulatory characteristics which may be of use in the treatment of cervical intraepithelial neoplasia (CIN). Intralesional administration may avoid systemic side effects. Twenty-six women with cervical punch biopsy proven CIN I and II were treated by interferon injection into the cervical transformation zone according to three dosage regimens--6 million international units (IU) weekly for six weeks, 9 million IU weekly for six weeks and 12 million IU bi-weekly for three weeks. At the last treatment visit, cervical cytology and biopsy were taken to ensure no disease progression and large loop excision of the transformation zone (LLETZ) was carried out six months after treatment. Therapy was well-tolerated with 93% of the scheduled 156 treatments given. Side effects which caused cessation of treatment included severe myalgia, headaches and prolonged flu-like symptoms. The 2 patients who failed to attend for LLETZ at six months and another 2 patients who received fewer than five scheduled treatments were excluded from analysis. LLETZ histology was negative in 12 patients (54%), showed inflammatory changes or squamous metaplasia in 4 (18%), was unchanged in 4 patients and had progressed in 2 (10%). Whilst intralesional beta-interferon clearly has activity in CIN, the response rate is less than that seen for excisional or ablative procedures. Nevertheless, it may have a role in the management of CIN where, for medical reasons of patient preference, there is a desire to avoid surgical therapy.
Adult↗
Virtual colonography: techniques and current clinical applications.
The advent of volumetric helical computed tomography (CT), coupled with the almost universal use of oral and intravenous contrast agents, has resulted in CT becoming the diagnostic and therapeutic cornerstone for alimentary tract disease. Recent technical advances, further enhanced by innovative software developments, now permit multiplanar and endoluminal projections of the entire abdomen, and have resulted in the development of novel diagnostic applications in the abdomen.
Journal Article↗
Using matrix-assisted laser desorption ionization mass spectrometry to map the quinol binding site of cytochrome bo3 from Escherichia coli.
The cytochrome bo3 ubiquinol oxidase contains at least one and possibly two binding sites for ubiquinol/ubiquinone. Previous studies used the photoreactive affinity label 3-[3H]azido-2-methyl-5-methoxy-6-geranyl-1,4-benzoquinone (azido-Q), a substrate analogue, to demonstrate that subunit II contributes to at least one of the quinol binding sites. In the current work, mass spectroscopy is used to identify a peptide within subunit II that is photolabeled by the azido-Q. Purified cytochrome bo3 was photolabeled as previously described using azido-Q that was not tritiated (i.e., not radiolabeled). Subunit II was then isolated from an SDS-PAGE gel and proteolyzed in situ with trypsin. The resulting peptides were eluted from the gel and then identified using matrix-assisted laser desorption ionization mass spectrometry. The resulting mass spectrum was compared to that obtained by analysis of subunit II that had not been exposed to the photolabel. Using the amino acid sequence, each peak in the mass spectrum of the unlabeled subunit II could be assigned to an expected trypsin fragment. Two additional peaks were observed in the mass spectrum of the photolabeled subunit with m/z 1931.9 and 2287.7. Subtraction of the mass of azido-Q from the peak at m/z 1931.9 results in a mass equivalent to that of a peptide consisting of amino acids 165-178. The assignment of the peak at m/z 2287.7 cannot be made unequivocally and may correspond either to the covalent attachment of azido-Q to peptide 254-270 or to a peptide resulting from incomplete proteolysis. The labeled peptide, 165-178, is within the water-soluble domain of subunit II, whose X-ray structure is known. This peptide is located near the site where CuA is located in the homologous cytochrome c oxidases and can be placed near the interface between subunits I and II.
Binding Sites↗
Hypoalgesia in mice with a targeted deletion of the tachykinin 1 gene.
The tachykinin neuropeptides, substance P and substance K, are produced in nociceptive primary sensory neurons and in many brain regions involved in pain signaling. However, the precise role and importance of these neuropeptides in pain responses has been debated. We now show that mice that cannot produce these peptides display no significant pain responses following formalin injection and have an increased pain threshold in the hotplate test. On the other hand, the mutant mice react normally in the tail flick assay and acetic acid-induced writhing tests. These results demonstrate that substance P and/or substance K have essential functions in specific responses to pain.
Acetic Acid↗
Cytomegalovirus-specific IFNgamma and IL-4 are produced by antigen expanded human blood lymphocytes from seropositive volunteers.
The cytokine responses to cytomegalovirus (CMV) antigen in seropositive and seronegative individuals were measured using a combination of antigenic expansion and intracellular staining. Intracellular IFNgamma and IL-4 were produced in a dose-dependent manner by T cells in response to CMV only in the seropositive population. The potential for individual cells to produce both Th1 and Th2 cytokines simultaneously was clear, as IL-4 was most often produced in those cells with the highest IFNgamma production. The cytokine-specific nature of this response was demonstrated by fluorescence microscopy, which showed granular cytoplasmic staining, and at the mRNA level by ribonuclease protection assays. These methods expand our ability to evaluate the immune response to CMV, and can now be correlated to a number of clinical conditions.
Adult↗
Influence of an antiperspirant on foot blister incidence during cross-country hiking.
BACKGROUND: Rubbing moist skin results in higher frictional forces than rubbing very dry skin. As friction increases, the probability of activity-related blisters also increases. Therefore reducing moisture may reduce blister incidence during physical activity. OBJECTIVE: We examined whether an antiperspirant can reduce foot blisters during hiking. METHODS: In a double-blind study, cadets attending the US Military Academy were separated into two groups that used either an antiperspirant (20% aluminum chloride hexahydrate in anhydrous ethyl alcohol) or placebo (anhydrous ethyl alcohol) preparation. Cadets were told to apply preparations to their feet for 5 consecutive nights. On day 6, cadets completed a 21-km hike, and their feet were examined for blisters before and after. RESULTS: Because of dropouts, the final sample size was 667 cadets with 328 in the antiperspirant group and 339 in the placebo group. There was a high rate of noncompliance with the treatment schedule: Cadets used the preparations from 0 to 5 nights before the hike. For cadets using the preparations at least 3 nights before the hike (n=269), the incidence of foot blisters was 21% for the antiperspirant group and 48% for the placebo group (P < 0.01). However, reports of skin irritation were 57% for the antiperspirant group and 6% for the placebo group (P < 0.01). CONCLUSION: A 20% solution of aluminum chloride hexahydrate in anhydrous ethyl alcohol may be effective in reducing foot blisters during hiking; however, the side effect of skin irritation should be considered and preventive measures studied to reduce this irritation.
Aluminum Chloride↗
POU transcription factors control expression of CNS stem cell-specific genes.
Multipotential stem cells throughout the developing central nervous system have common properties. Among these is expression of the intermediate filament protein nestin and the brain fatty acid binding protein (B-FABP). To determine if common mechanisms control transcription in CNS stem cells, the regulatory elements of these two genes were mapped in transgenic mice. A 257 basepair enhancer of the rat nestin gene is sufficient for expression throughout the embryonic neuroepithelium. This enhancer contains two sites bound by the class III POU proteins Brn-1, Brn-2, Brn-4, and Tst-1. Only one of the two POU sites is required for CNS expression. An adjacent hormone response element is necessary for expression in the dorsal midbrain and forebrain. The regulatory sites of the B-FABP gene are strikingly similar to those of the nestin gene. A hybrid POU/Pbx binding site is recognized in vitro by Pbx-1, Brn-1 and Brn-2. This site is essential for expression in most of the CNS. In addition, a hormone response element is necessary for forebrain expression. Both the nestin and B-FABP genes therefore depend on POU binding sites for general CNS expression, with hormone response elements additionally required for activity in the anterior CNS. These data indicate that regulation by POU proteins and hormone receptors is a general mechanism for CNS stem cell-specific transcription.
Animals↗
The feasibility of assessing women's perceptions of the risks and benefits of fertility drug therapy in relation to ovarian cancer risk.
OBJECTIVE: To determine the feasibility of asking women undergoing fertility treatment the maximum increased risk of ovarian cancer they would be willing to tolerate in order to take ovulation-induction drugs. DESIGN: A prospective pilot study of women attending fertility clinics over a 2-month period. SETTING: Two tertiary care fertility clinics in Toronto. PATIENT(S): Sixty-one English-speaking women were approached and 85% (n = 52) were enrolled. INTERVENTION(S): A self-administered questionnaire with fertility-specific questions. Thirty-eight women also were asked to complete standardized scales of anxiety and optimism. MAIN OUTCOME MEASURE(S): Women's report of the maximum level of lifetime risk of ovarian cancer they were willing to tolerate in order to undergo fertility treatment. RESULT(S): Seventy-nine percent were willing to accept an increased risk of ovarian cancer. Only 24% understood that treatment for ovarian cancer usually was not curative. CONCLUSION(S): A majority of patients were willing to tolerate a modest increase in their lifetime risk of ovarian cancer because of fertility treatment, most basing their estimate of acceptable risk on limited awareness of the issue.
Adult↗