Symbiosis of esthetics and occlusion: thoughts and opinions of a master of esthetic dentistry.
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Bite Force↗
Biomedical subjects
L Miller
Publications and source records attributed to L Miller.
Critical incident stress debriefing: clinical applications and new directions.
Critical Incident Stress Debriefing (CISD) was originally developed as a short-term, group-format, preventive mental health intervention for traumatized law enforcement and emergency services personnel. The debriefing model has since been applied to a variety of clinical groups and crisis situations, correspondingly undergoing modifications in its structure and process. This review describes the CISD approach and explores some of the new directions being taken by practitioners of this intervention strategy. In addition, this review addresses some of the recent critiques of the CISD model, and makes recommendations for optimal utilization of this clinical tool with those populations most likely to benefit from it.
Crisis Intervention↗
Cost of smoking to the Medicare program, 1993.
Medicare expenditures attributable to smoking in 1993 were estimated using a multivariate model that related expenditures to smoking history, health status, and the propensity to have had a smoking-related disease, controlling for sociodemographics, economic variables, and other risk factors. Smoking-attributable Medicare expenditures are presented separately for each State and by type of expenditure. Nationally, smoking accounted for 9.4 percent of Medicare expenditures--$14.2 billion, with considerable variation among States. Smoking accounted for 11.4 percent of Medicare expenditures for hospital care, 11.3 percent of nursing home care, 5.9 percent of home health care, and 5.6 percent of ambulatory care.
Aged↗
A randomized active-controlled trial of mycophenolate mofetil in heart transplant recipients. Mycophenolate Mofetil Investigators.
BACKGROUND: After heart transplantation, 1-year and 5-year survival rates are 79% and 63%, respectively, with rejection, infection, and allograft coronary artery disease accounting for the majority of deaths. Mycophenolate mofetil (MMF), an inhibitor of the de novo pathway for purine biosynthesis, decreases rejection in animals and in human renal transplantation. METHODS: In a double-blind, active-controlled trial, 28 centers randomized 650 patients undergoing their first heart transplant to receive MMF (3000 mg/day) or azathioprine (1.5-3 mg/kg/day), in addition to cyclosporine and corticosteroids. Rejection and survival data were obtained for 6 and 12 months, respectively. Because 11% of the patients withdrew before receiving study drug, data were analyzed on all randomized patients (enrolled patients) and on patients who received study medications (treated patients). RESULTS: Survival and rejection were similar in enrolled patients (MMF, n=327; azathioprine, n=323). In treated patients (MMF, n=289; azathioprine, n=289), the MMF group compared with the azathioprine group was associated with significant reduction in mortality at 1 year (18 [6.2%] versus 33 deaths [11.4%]; P=0.031) and a significant reduction in the requirement for rejection treatment (65.7% versus 73.7%; P=0.026). There was a trend for fewer MMF patients to have > or = grade 3A rejection (45.0% versus 52.9%; P=0.055) or require the murine monoclonal anti-CD3 antibody or antithymocyte globulin (15.2% versus 21.1%; P=0.061). Opportunistic infections, mostly herpes simplex, were more common in the MMF group (53.3% versus 43.6%; P=0.025). CONCLUSIONS: Substitution of MMF for azathioprine may reduce mortality and rejection in the first year after cardiac transplantation.
Aged↗
Regulation of TNF-alpha production in activated mouse macrophages by progesterone.
The purpose of this study was to investigate the relationships between macrophage production of TNF-alpha and female hormones. Northern blot hybridization experiments showed that the female sex steroid hormone, progesterone, decreases steady state levels of TNF-alpha mRNA in LPS-activated mouse macrophages (RAW 264.7 and ANA-1 cells) in vitro. The production of intracellular and secreted TNF-alpha protein, as determined by ELISA, was decreased in both progesterone- and dexamethasone-treated, LPS-stimulated macrophages. Estrogen had no effect on expression of the TNF-alpha gene in mouse macrophages and did not alter progesterone-mediated suppression. Additional experiments conducted to investigate the mechanism of action of progesterone showed that this hormone, like dexamethasone, elevates steady state mRNA levels of IkappaB alpha and increases the levels of IkappaB alpha protein that are translocated from the cytoplasm to the nucleus. Thus, progesterone is a potent inhibitor of steady state levels TNF-alpha mRNA and TNF-alpha protein production in activated macrophages and may achieve this result through effects on an inhibitor of NF-kappaB.
Animals↗
Lack of developmental and reproductive toxicity of 2,3,3',4, 4'-pentachlorobiphenyl (PCB 105) in ring-necked pheasants.
Mono-ortho PCBs are global contaminants of wildlife with the potential to produce toxicity by an aryl hydrocarbon receptor (AhR)-mediated mechanism. To determine the potency of 2,3,3',4, 4'-pentachlorobiphenyl (PCB 105) for producing reproductive and developmental toxicity, adult ring-necked pheasant hens (Phasianus colchicus) were orally dosed with 0, 0.06, 0.6, or 6 mg PCB 105/kg hen/week for 10 weeks to achieve cumulative doses of 0, 0.6, 6, or 60 mg PCB 105/kg hen after which hens were bred with untreated roosters once per week for 8 weeks. Except at week 6 of the egg-laying period when cumulative egg production in the 6 mg PCB 105/kg hen group was greater than controls, fertilized egg production was not significantly different between treatment groups. Embryo mortality and chick mortality were not significantly different between treatment groups. Total body and heart weights of all chicks 1 day posthatch (dph) were not different between groups, however, liver weights of chicks from the 60 mg/kg treatment group were greater than controls at 1 dph. The first chick to hatch from each hen was reared to 21 dph and among these birds, the total body, liver, and heart weights were not different between groups. There were no dose-related malformations of the beak or limbs, and no signs of subcutaneous edema, ascites, or pericardial edema in chicks at 1 or 21 dph. Hepatic microsomal monooxygenase activities [ethoxyresorufin-O-dealkylase (EROD), benzyloxyresorufin-O-dealkylase (BROD), and methyloxyresorufin-O-dealkylase (MROD)] were significantly elevated in chicks at 1 dph from hens given a cumulative PCB 105 dose of 6 mg/kg and in chicks at 21 dph from hens given a cumulative PCB dose of 60 mg/kg. These results indicate that a cumulative PCB 105 dose up to 60 mg/kg hen does not decrease the production of fertilized eggs or increase embryo or chick mortality in ring-necked pheasants, but does increase chick hepatic monooxygenase activity.
Animals↗
Intradermal proximal field block: an innovative anesthetic technique for levonorgestrel implant removal.
BACKGROUND: Levonorgestrel implant removal is a common office procedure. These procedures can be difficult and uncomfortable for the woman. Many removal techniques use only small amounts of lidocaine to diminish tissue distortion and to allow palpation of the implants. We report an alternative technique that can maximize the anesthesia during removal procedures. TECHNIQUE: Using the "ice saline" technique, lidocaine is infiltrated proximal to the implant tips, creating a field block of the superficial medial antebrachial cutaneous nerves and anesthetizing the operative site without injecting lidocaine around the implants. EXPERIENCE: We began using this technique 3 years ago and have used it for more than 50 removals. There have been no complications, and the block appears to reduce the pain reported. CONCLUSION: The proximal intradermal field block is an alternative anesthetic technique for levonorgestrel implant removal.
Anesthetics, Local↗
Heart period variability and psychopathology in urban boys at risk for delinquency.
To examine associations between heart period variability (HPV) and psychopathology in young urban boys at risk for delinquency, a series of 697-11-year-old younger brothers of adjudicated delinquents received a standardized psychiatric evaluation and an assessment of heart period variability (HPV). Psychiatric symptoms were rated in two domains: externalizing and internalizing psychopathology. Continuous measures of both externalizing and internalizing psychopathology were associated with reductions in HPV components related to parasympathetic activity. These associations could not be explained by a number of potentially confounding variables, such as age, ethnicity, social class, body size, or family history of hypertension. Although familial hypertension predicted reduced HPV and externalizing psychopathology, associations between externalizing psychopathology and HPV were independent of familial hypertension. Psychiatric symptoms are associated with reduced HPV in young urban boys at risk for delinquency.
Blood Pressure↗
Evaluation of zinc metabolism with use of stable-isotope techniques: implications for the assessment of zinc status.
Zinc stable isotopes can be applied to the identification of populations at risk for zinc deficiency and to monitoring the effects of zinc intervention studies designed to improve zinc nutriture. Techniques using these isotopes can provide information on how effectively the intestine is absorbing exogenous dietary zinc and conserving endogenous zinc. They can also yield estimates of the quantity of readily exchangeable zinc in the body. Data derived from stable-isotope studies can provide extensive information on zinc status and the bioavailability of dietary zinc, allowing researchers to relate zinc intake to physiologic and pathologic conditions. Application of these techniques in longitudinal studies can provide quantitative data on the effectiveness of prevention programs such as simple community measures aimed at reducing dietary phytate and zinc fortification and supplementation programs. Further, judicious application of zinc stable-isotope techniques could make an important contribution to progress toward the eradication of zinc deficiency in infants and young children in the developing world.
Animals↗
Assessment of pain during medical procedures: a comparison of three scales.
OBJECTIVE: Pain assessment is crucial to pain research. Knowledge about the strengths and weaknesses of pain measures is important to the continued advancement of our understanding of pain. The purpose of the present study was to compare the validity and utility of three measures of pain intensity during a medical procedure known to produce pain: an abortion. DESIGN: Assignment to one of three pain intensity assessment instruments, which were subsequently used to assess pain during an abortion procedure. Comparison of the relative sensitivity of the measures to assess changes in pain using a series of repeated measures analyses of variance. The relative utility of the measures was compared by examining the rates of accurate responses to each. SUBJECTS: Fifty-eight women presenting for a first-trimester abortion. MEASURES: Visual analog scale (VAS), the verbal 11-point Box Scale (Verbal BS-11), and the 21-point Box Scale (BS-21). RESULTS: All three pain intensity measures detected changes in pain during the abortion procedure. Rates of incorrect responses were higher for the Verbal BS-11 and the VAS than for the BS-21. CONCLUSIONS: The results supported the validity of each of the three measures used, although some superiority for the BS-21 over the Verbal BS- 11 and VAS exists. Patients had some difficulty completing the paper-and-pencil VAS during the procedure. In addition and consistent with previous research, some patients treated the Verbal BS-11 as a 21-point scale by responding with numbers between two whole numbers on the 0-10 measure. Overall, practical issues led us to conclude that the BS-21 is an excellent choice for assessing real-time abortion pain.
Abortion, Induced↗
Effect of pancreatic enzymes on zinc absorption in cystic fibrosis.
BACKGROUND: The trace metal zinc has a wide range of important physiologic roles. Indirect evidence suggests that fat malabsorption is associated with malabsorption of zinc. The objective of this study was to evaluate the effect of pancreatic enzyme replacement on zinc absorption in children and adolescents with cystic fibrosis. METHODS: Subjects were four boys and four girls ranging in age from 7 to 17 years of age. All were pancreatic insufficient. Stable isotope labels, 70Zn and 67Zn, were administered orally in divided doses on consecutive days with meals. Meals were identical on the first 2 study days. Subjects were randomized to have pancreatic enzyme replacement withheld on the first or second day. All fecal samples were collected quantitatively for 10 days after label administration and were analyzed individually for total zinc and isotopic enrichment using atomic absorption spectrophotometry and fast atom bombardment mass spectrometry, respectively. Fractional absorption of zinc was calculated from cumulative fecal excretion of unabsorbed label. RESULTS: Fractional absorption while receiving enzymes was 0.50 +/- 0.29 versus 0.38 +/- 0.24 while not taking enzymes (p = 0.05). CONCLUSIONS: These results indicate that fractional absorption of zinc is impaired by pancreatic insufficiency in patients with cystic fibrosis, and is improved by exocrine pancreatic enzyme replacement.
Adolescent↗
Hormonal regulation of uterine macrophages.
Macrophages are major cellular inhabitants of cycling and pregnant mammalian uteri. Their densities and patterns of tissue distribution in this organ fluctuate in concert with levels of circulating female sex steroid hormones, estrogens and progesterone, and their production of various effector molecules also may be hormonally regulated. Hormonal control may be achieved by direct binding to receptors or by indirect pathways where hormones modulate production of various autocrine and paracrine cytokines and growth factors that then target to resident macrophages and influence their secretory profiles. In this paper, we marshall evidence supporting the concept that progesterone acts as a powerful negative regulator of these versatile cells, reducing their migration into the uterus and impairing their ability to produce potent effector molecules such as nitric oxide that could interfere with the success of pregnancy.
Animals↗
Depression among pregnant adolescents.
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Adolescent↗
Discovery of ascomycin analogs with potent topical but weak systemic activity for treatment of inflammatory skin diseases.
Drug therapy for the major inflammatory skin diseases, which include atopic dermatitis, psoriasis and allergic contact dermatitis, is often inadequate due to poor efficacy, toxicity, or both. Much research has focused on the macrolactam T cell inhibitors as a promising new class of agents for immunotherapy, and medicinal chemistry efforts to design novel ascomycin analogs have produced clinically promising agents. A synthetic program to modify the ascomycin nucleus to alter its physicochemical properties and promote systemic clearance is described. A biologic screening strategy to identify analogs with reduced systemic activity and rapid pharmacokinetic elimination led to identification of the clinical candidate, ABT-281. A swine contact hypersensitivity model was used as a stringent indicator of skin penetration as human doses of topical corticosteroids produced inhibition only in the 50% range and ED50 values were 100-fold less potent than in rat. Also, cyclosporine was confirmed to be topically inactive in swine, as seen in human. ABT-281 had topical potency equal to tacrolimus (FK506) despite a severalfold lower potency for inhibiting swine T cells in vitro, consistent with superior skin penetration. ABT-281 was found to have a shorter duration of action after i.v. dosing in monkeys using an ex vivo whole blood IL-2 production assay. Systemic potency was reduced by 30-fold or more in rat popliteal lymph node hyperplasia and contact hypersensitivity assays. Following i.v. or i.p. administration in the swine contact hypersensitivity model, ABT-281 was 19- and 61-fold less potent, respectively, than FK506. Pharmacokinetic studies showed that ABT-281 had a shorter half life and higher rate of clearance than FK506 in all three species. The potent topical activity and reduced systemic exposure of ABT-281 may thus provide both efficacy and a greater margin of safety for topical therapy of skin diseases.
Administration, Topical↗
Immunoglobulin and IgG subclass levels in the African American and Hispanic populations of east Harlem.
BACKGROUND: The normal levels of immunoglobulin and IgG subclasses in African American and Hispanic populations are uncertain. To determine immunoglobulin and IgG subclass levels in this community, we measured serum IgG, IgM, and IgA levels along with IgG subclasses in 303 African American and Hispanic patients in a general medical clinic and an allergy/asthma clinic in East Harlem in New York City. METHODS: Prospective measurement of immunoglobulins and IgG subclasses in a general medical clinic and an allergy/asthma clinic in East Harlem. RESULTS: Ten (3.4%) patients had IgG levels below the lower limit of normal values, two (0.07%) patients had IgA levels below the lower limit of normal values, and two (0.07%) patients had an IgM level below the lower limit of normal values. Twenty-four (8.1%) patients had IgG subclass levels below the lower limit of normal values; 1 patient had low levels of IgG1 and IgG3, 5 patients had low levels of IgG2, and 18 patients had low levels of IgG3. Because low IgG subclasses and allergy/asthma appeared to be associated, we compared IgG subclass levels of the patients with and without allergy/asthma. The mean IgG2 level in the patients without allergy/asthma was 425.1 +/- 199.1 mg/dL (p = 0.05) compared with 345.5 +/- 133.1 mg/dL in the allergy/asthma group, the mean IgG3 level in the patients without allergy/asthma was 85.0 +/- 57.1 mg/dL compared with 64 +/- 34.1 mg/dL in the allergy/asthma group (p = 0.016) but there were no differences in IgG1 and IgG4 levels between the two groups. CONCLUSION: Altogether, our data indicate that humoral immunoglobulin and IgG subclass levels below the lowest normal values occur in the low socioeconomic African American and Hispanic populations, especially in patients with asthma in East Harlem.
Adult↗
Breaking the boundaries: collaborating to develop a model ventilator training program.
Changes in the health care system have created new opportunities for acute care nurses to establish collaborative relationships with their rehabilitation partners. When a rehabilitation facility decided to establish a ventilator weaning rehabilitation program, an acute care facility joined forces with the institution to develop an educational plan for the nursing staff. The development and implementation of the educational program as well as the collaborative relationship established between the two facilities are highlighted in this continuing education article.
Curriculum↗
Cholecystadenocarcinoma in a cat.
A malignant neoplastic process originating from gall bladder epithelium was diagnosed in a 14-year-old, spayed female, domestic shorthair cat. The tumor produced widespread pulmonary and lymphatic metastases. The clinical and pathological manifestations are described. Neoplasia arising from the gall bladder epithelium is rarely reported in animals.
Adenocarcinoma↗
Ego autonomy and the healthy personality: psychodynamics, cognitive style, and clinical applications.
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Cognitive Behavioral Therapy↗