Cloning position paper of the IIT Institute for Science, Law and Technology Working Group on Reproductive Technologies.
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Advisory Committees↗
Biomedical subjects
L Andrews
Publications and source records attributed to L Andrews.
Do the dead have interests? Policy issues for research after life.
The importance of establishing rights in a dead body has been, and will continue to be, magnified by scientific advancements. The recent explosion of research and information concerning biotechnology has created a market place in which human tissues are routinely sold to and by scientists, physicians and others. The human body is a valuable resource.
Autopsy↗
The role of cell adhesion molecules in craniofacial development.
The last decade has seen classification and characterization of previously identified glycoproteins which have been associated with cell adhesion. More recently, it has been realized that the range of these molecules is even wider than originally thought. Cell adhesion molecules are important in early development and their role in craniofacial development is now apparent. Furthermore, the interaction of cell adhesion molecules in other developmental phenomena such as epithelial mesenchymal transformation (EMT), reinforces the suggestion that these molecules are important in the later stages of development, particularly organogenesis. This article reviews the role of cell adhesion molecules in embryogenesis, with a particular emphasis on foetal craniofacial development.
Cell Adhesion Molecules↗
Adaptation and validation of a portable steam sterilizer for processing intrauterine device insertion instruments and supplies in low-resource settings.
BACKGROUND: Difficulties with adequately processing intrauterine device (IUD) insertion instruments and supplies have led to use of potentially contaminated items, compromising the quality and safety of IUD insertion services in Bangladesh. A sterilization process for IUD insertion instruments and supplies by using a commercially available portable steam sterilizer was developed and validated. METHODS: Racks provided with the sterilizer were used during sterilization of wrapped supplies (gloves and cotton balls). Metal compartments to hold insertion instruments were built to fit into the sterilizer. After sterilization, supplies were transported to rural service sites in plastic bags, whereas instruments remained in the sterilizer, which was transported in a carrying case. To validate the sterilizer, laboratory testing was conducted by using chemical and biologic indicators for steam sterilization and field testing in Bangladesh with chemical indicators. RESULTS: Results indicated that sterilization cycles were effective in achieving sterility of IUD insertion supplies and instruments at sterility assurance levels of 10(-5) and 10(-6), respectively. CONCLUSIONS: Use of this sterilizer for IUD insertion supplies and instruments will improve the quality of service delivery in the Bangladesh family-planning program and has application for use in many other low-resource settings.
Bangladesh↗
The incidence of deep venous thrombosis in ICU patients.
STUDY OBJECTIVE: To determine the incidence, clinical presentation, and risk factors of deep venous thrombosis (DVT) in a high-risk group of ICU patients receiving DVT prophylaxis. DESIGN: A prospective cohort study. SETTING: Two ICUs of a university-affiliated teaching hospital. PATIENTS: Patients admitted to the ICUs within 48 h of hospitalization and who had an ICU stay of > or = 4 days underwent venous duplex scans. INTERVENTIONS: None. RESULTS: One hundred two patients were studied. Ninety-four (92%) patients received DVT prophylaxis. Twelve patients (12%) were documented to have DVT by venous duplex scans. There was proximal clot extension in eight of these patients, four of whom had high-probability ventilation/perfusion scans. Of the 56 patients without signs or symptoms of DVT, only two (3.6%) had abnormal scans. Leg swelling was present in 11 patients, six of whom had DVT (p = 0.004). One of 11 patients with unexplained fever had an abnormal scan. Five of the 26 patients (19%) receiving pneumatic compression developed DVT compared with five of 68 patients (7.4%) receiving subcutaneous heparin (not significant). No specific factor was identified that increased the risk of DVT. CONCLUSION: In this study, the incidence of DVT in a group of high-risk ICU patients receiving DVT prophylaxis was 12%. Since scans in patients without signs or symptoms suggestive of DVT were abnormal in only 3.6% of patients, venous scans should be performed only in patients with features suggestive of DVT or pulmonary embolism.
Aged↗
The Bell Curve: statement by the NIH-DOE Joint Working Group on the Ethical, Legal, and Social Implications of Human Genome Research.
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Bioethics↗
Telling patients the truth.
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Communication↗
Informed consent for genetic research on stored tissue samples.
OBJECTIVE: To develop recommendations for obtaining adequate informed consent in the future when gathering tissue samples that may be used for genetic studies and defining the circumstances under which it is necessary to obtain further consent if tissue samples already in hand are to be used for such research. PARTICIPANTS: Scientists, ethicists, lawyers, and consumers selected by the National Center for Human Genome Research and the Centers for Disease Control and Prevention to represent a wide array of opinions. EVIDENCE: Statutes, regulations, and cases and articles on law and ethics. CONSENSUS PROCESS: Initial workshop, followed by circulation of several drafts of this document with opportunities for comment by workshop participants and others as well as smaller meetings involving participants with widely differing views. CONCLUSION: Genetic research using stored tissue samples poses an array of benefits and risks to individuals, researchers, and society. As a result, the workshop participants conclude that (1) informed consent is required for all genetic research using linkable samples unless conditions for limitation or waiver are met; (2) informed consent is not required for genetic research using anonymous samples but may be considered if identifiers are to be removed from currently linkable samples; (3) institutional review boards could usefully review all protocols that propose to use samples for genetic research; and (4) further work regarding these issues is warranted.
Anonymous Testing↗
Wise purchasing under healthcare reform.
Group Health Cooperative of Puget Sound (Seattle, WA) believes that wise purchasing practices contribute both to cost efficiency and high quality healthcare delivery. At Group Health Cooperative, we came by this belief through a variety of forces all pushing for healthcare reform--legislative-, market-, and consumer-driven forces. At nearly fifty years of age, Group Health Cooperative of Puget Sound is the oldest health maintenance organizations (HMO) in the country. As in the beginning, Group Health is still a consumer-governed cooperative that has grown to over 400,000 enrollees, 44,000 of whom are seniors. The Co-op has a mixed staff/group/network physician model. Its 1994 budget was over $1 billion, with Medicare revenue accounting for about 30% of the budget. For nearly its first four decades, Group Health was just about the only show in town. If you wanted prepaid healthcare or independent consumer oversight for quality of care, you joined Group Health. But by the mid-1980s, there were over twenty other managed care competitors. Some were local health plans with a sideline managed-care business, but, increasingly, competitors included huge, national, for-profit corporations. In addition, two other streams of change pressured healthcare in the Seattle area and elsewhere--legislative and market reform. In Washington, legislative reform started in 1989 with the Basic Health Plan, a program to aid the working poor by subsidizing their healthcare insurance premiums based on financial need.(ABSTRACT TRUNCATED AT 250 WORDS)
Capitation Fee↗
An improved procedure for enzymatic digestion of polyvinylidene difluoride-bound proteins for internal sequence analysis.
An improved and simplified procedure for enzymatic digestion of proteins bound to polyvinylidene difluoride (PVDF) membranes for obtaining internal protein sequence data is presented. This improved procedure is compatible with various enzymes (trypsin, endoproteinase Lys-C, endoproteinase Glu-C, and clostripain) and is performed in the presence of 1% hydrogenated Triton X-100 (RTX-100)/10% acetonitrile/100 mM Tris, pH 8.0, followed by microbore HPLC purification of the recovered peptides. Previously published techniques required treatment of the PVDF-bound protein with polyvinylpyrrolidine M(r) 40,000 (PVP-40) prior to digestion, in order to prevent adsorption of the enzyme to the membrane. Unfortunately, contaminants produced from residual PVP-40 interfere with subsequent peptide mapping. We have found that when RTX-100 is used in the digestion buffer, no pretreatment of the PVDF-bound protein with PVP-40 is necessary. Advantages of this improved (one-step) procedure over the two-step PVP-40 procedure are (a) the elimination of undesirable contaminants associated with PVP-40, (b) a decrease in the time required for the technique, and (c) a reduction in sample manipulation. Peptide maps and recoveries from PVDF-bound standard proteins (4 micrograms each) enzymatically digested with this one-step method are compared with those obtained from the standard PVP-40 method. In addition, peptide maps and internal sequence data from low-level quantities of unknown proteins enzymatically digested with the improved procedure are presented. To date, this improved, one-step procedure has been successfully applied to 52 PVDF-bound unknown proteins (0.7-10 micrograms) of varying molecular weight (19-300 kDa) for which internal sequence data were obtained.
Amino Acid Sequence↗
American College of Surgeons trauma quality indicators: an analysis of outcome in a statewide trauma registry.
Quality assurance/quality improvement (QA-QI) is a priority for maintaining the highest standards of care in trauma systems. To be an effective tool for system review, the QA-QI indicators should identify patients with higher rates of morbidity and mortality from injury. While the American College of Surgeons (ACS) and the Joint Commission on Accreditation of Health Care Operations have identified certain audit filters within the trauma system, there are few data to substantiate the value of these audit filters for trauma care. The purpose of this study was to analyze the ability of the ACS trauma indicators to predict adverse patient outcome following injury requiring review. The study population consisted of 44,019 patients from the North Carolina State Trauma Registry from 1987 to 1992. Of the 22 audit filters nine were available for analysis. Mortality rate, length of stay, and total charges were used as measures of outcome. The hypotheses tested were that patients who met the indicator criteria would have higher mortality rates and worse outcomes than the non-indicator group. Student's t test and Chi-square analysis were used to test the differences between the group which met the criteria for the indicator and those without. Of the nine audit filters tested, only three were found to have significantly worse outcomes than their non-indicator comparison group: gunshot wound to the abdomen with non-surgical management, femur fracture without fixation, and complications from pulmonary embolism-deep vein thrombosis-decubitus ulcer (p < 0.05). Contrary to expectations, four of the audit filters, coma without intubation, laparotomy > 2 hours, transfer > 6 hours, and admission to non-surgical service, actually had significantly better outcomes than their non-indicator counterpart. Scene time > 20 minutes, laparotomy > 2 hours after arrival, and craniotomy > 4 hours after arrival may be indicators of patients at risk for morbidity. This study demonstrates that several ACS clinical indicators, as currently written, are not useful in identifying patients at higher risk for poor outcome. The indicators need further definition to be of value in the quality review process. Specifically, the study suggests that audit filters should be data driven and based upon analyses of large populations of injured patients and their outcomes to be valid QA-QI tools.
General Surgery↗
Manic-depressive tendencies and acceptance of self and others.
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Adolescent↗
Medical management of pulmonary emboli.
Pulmonary embolism is a potentially fatal condition that can be difficult to diagnose and manage. Intravenous heparin is the mainstay of therapy but thrombolytic agents hold promise for reducing long-term pulmonary problems. Medical-surgical nurses must be prepared to recognize the early symptoms of pulmonary embolism and intervene to prevent untoward outcomes.
Anticoagulants↗
A modified, angioscopically assisted technique for in situ saphenous vein bypass: impact on patency, complications, and length of stay.
PURPOSE: The impact of preoperative saphenous vein mapping and intraoperative angioscopy on the results of in situ saphenous vein bypass is analyzed in this study. METHODS: A new technique developed for in situ saphenous vein bypass (ISVB) was used in 26 patients (group I) and consisted of (1) preoperative duplex scanning and mapping of the saphenous vein and its tributaries, (2) small incisions for dissecting the proximal and distal arteries and veins, (3) ligation of marked tributaries through small incisions, (4) angioscopically directed incision of venous valves with a flexible-tipped valvulotome, and (5) femoral and distal anastomoses. The results were compared with those of 14 patients (group II) in whom the technique was similar except that venous tributaries were identified angioscopically and then ligated and 24 patients (group III) who underwent standard "open" ISVB through one long incision without angioscopy or vein mapping and in whom valvulotomy was carried out with a rigid valvulotome passed through tributaries. RESULTS: In comparing the results of groups I and III, significant reductions in operative intravenous fluid requirements (1930 ml vs 2675 ml; p = 0.04), postoperative length of stay (4.4 days vs 9.1 days; p < 0.001), and wound complications (1 vs 9; p = 0.01) were observed. Angioscopic irrigation fluid volume in group I was less than that in group II (360 ml vs 1014 ml; p < 0.001). At 12 months, the primary graft patency rate in all 64 patients was 91% for femoropopliteal and 89% for femoral-infrapopliteal ISBV and 84% for the 40 patients in groups I and II. CONCLUSIONS: This report demonstrates the effectiveness of our modified technique for ISVB, which helped reduce wound complications and length of stay while satisfactory early graft patency was also maintained.
Aged↗
Financial aspects of the provision of care to AIDS patients at Hartford Hospital.
Data on the provision of care to persons with AIDS at Hartford Hospital are presented for the years 1988 and 1989. Approximately 2% of the total operating loss from uncompensated care at the hospital was due to patients with AIDS during both of those years. While the hospital continues to show a net surplus of revenues over expenses, the operating loss incurred by the hospital for the provision of care to hospitalized case-definition AIDS patients increased by 88.1% between 1988 and 1989.
Acquired Immunodeficiency Syndrome↗
Biologic markers in ethylene oxide-exposed workers and controls.
Ethylene oxide (EtO) is an alkylating agent and a model direct-acting mutagen and carcinogen. This study has evaluated a panel of biologic markers including EtO-hemoglobin adducts (EtO-Hb), sister-chromatid exchanges (SCEs), micronuclei, chromosomal aberrations (CAs), DNA single-strand breaks (SSB) and an index of DNA repair (ratio of UDS to NA-AAF-DNA binding) in the peripheral blood cells of 34 workers at a sterilization unit of a large university hospital and 23 controls working in the university library. Comprehensive environmental histories were obtained on each subject including detailed occupational and smoking histories. Industrial hygiene data obtained prior to the study and personal monitoring during the 8 years preceding the study showed that workers were subject to low-level exposure near or below the current Occupational Safety and Health Administration (OSHA) standard of 1 ppm (TWA). Personal monitoring data obtained during 2 weeks prior to blood sampling were uniformly less than 0.3 ppm (TWA). After adjusting for smoking, EtO workplace exposure was significantly (p less than 0.001) associated with EtO-Hb (a carcinogen-protein adduct) and 2 measures of SCEs [the average number of SCEs/cell (SCE50) and the number of high frequency cells (SCEHFC)]. There was an apparent suppression of DNA repair capacity in EtO-exposed individuals as measured by the DNA repair index; i.e., the ratio of unscheduled DNA synthesis (UDS) and NA-AAF-DNA binding (p less than 0.01). No association of DNA repair index with smoking was found. Another important finding of this study is the highly significant correlation between EtO-Hb adduct levels and SCEHFC (p less than 0.01) and SCEs (p less than 0.02) which provides evidence of a direct link between a marker of biologically effective dose and markers of genotoxic response. In contrast, micronuclei, CAs and SSBs were not significantly elevated in the workers. The activity of the u-isoenzyme of glutathione-S-transferase (GT) was measured as a possible genetic marker of susceptibility and a modulator of biomarker formation. However, possibly because of confounding by age, no significant relationships were found between GT and any of the exposure-related markers by ANOVA or among other independent variables by regression. This study demonstrates significant effects of low-level EtO exposure, independent of smoking history, near or below 1 ppm on multiple biomarkers and suggests that the current OSHA standard may not be adequately protective. Previously described effects of smoking on EtO-Hb adducts, SCEs and SCEHFC were also seen in this study.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Properties of the glucose phosphotransferase system of Clostridium acetobutylicum NCIB 8052.
The glucose phosphotransferase system (PTS) of Clostridium acetobutylicum was studied by using cell extracts. The system exhibited a Km for glucose of 34 microM, and glucose phosphorylation was inhibited competitively by mannose and 2-deoxyglucose. The analogs 3-O-methylglucoside and methyl alpha-glucoside did not inhibit glucose phosphorylation significantly. Activity showed no dependence on Mg2+ ions or on pH in the range 6.0 to 8.0. The PTS comprised both soluble and membrane-bound proteins, which interacted functionally with the PTSs of Clostridium pasteurianum, Bacillus subtilis, and Escherichia coli. In addition to a membrane-bound enzyme IIGlc, sugar phosphorylation assays in heterologous systems incorporating extracts of pts mutants of other organisms provided evidence for enzyme I, HPr, and IIIGlc components. The HPr was found in the soluble fraction of C. acetobutylicum extracts, whereas enzyme I, and probably also IIIGlc, was present in both the soluble and membrane fractions, suggesting a membrane location in the intact cell.
Bacillus subtilis↗
Detection of adducts of deoxyribonucleic acid in white blood cells of roofers by 32P-postlabeling. Relationship of adduct levels to measures of exposure to polycyclic aromatic hydrocarbons.
To assess the utility of adducts of deoxyribonucleic acid (DNA) as biomarkers of exposure to carcinogens in an industrial population, a pilot study of roofers occupationally exposed to polycyclic aromatic hydrocarbons was conducted. DNA isolated from white blood cells of roofers and nonoccupationally exposed comparison subjects matched for age, sex, and smoking status was analyzed for DNA adducts with the use of 32P-postlabeling methods. Occupational exposures to polycyclic aromatic hydrocarbons were assessed by personal air sampling and skin wipes. Ten of the 12 roofers, but only 2 of the 12 comparison subjects, had detectable levels of aromatic DNA adducts in the 32P-postlabeling assay. Among the roofers, the post-shift levels of polycyclic aromatic hydrocarbons in the skin wipes were correlated with the DNA adduct levels. These results suggest that 32P-postlabeling assay may be useful for monitoring internal exposures to complex mixtures of aromatic hydrocarbons in industrial populations.
Adult↗