Biomedical subjects

L S Miller

Publications and source records attributed to L S Miller.

At least 55 records · Page 3Linked to original sources

PubMed1996

Parenting predictors of early conduct problems in urban, high-risk boys.

OBJECTIVE: As part of a larger, prospective study, the authors examined concurrent and prospective relations among parenting and child antisocial behavior in inner-city boys at high risk for delinquent behavior. METHOD: One hundred twenty-six younger brothers (aged 6 to 10 years) of convicted delinquents in New York City and their parents were assessed; 15 months later 112 boys were reassessed. Demographics, parenting, and child diagnosis were examined as they relate to child externalizing behavior problems. Hierarchical multiple regression analyses predicted changes in Externalizing scores from year I parenting. RESULTS: At years I and II, 22% and 27% of boys, respectively, scored above the clinical cutoff for Externalizing. Controlling for earlier Externalizing, each of three domains of parenting still made significant independent contributions to later Externalizing scores, explaining 17% of the variance. Altogether this model explained 51% of the variance in year II Externalizing scores. CONCLUSIONS: Data support a cumulative risk model, whereby each of several adverse parenting factors further compounds the likelihood of child conduct problems.

Adolescent↗

PubMed1996

Caffeine enhances initial but not extended learning of a proprioceptive-based discrimination task in nonsmoking moderate users.

We examined the effects of caffeine on fine motor performance and learning using a multiple-force discrimination task. 93 college-aged subjects performed this task on which multiple measurements were made in an operant response paradigm. Quantitative measures of accuracy of response, duration of response, latency of response, force, and variability of force were examined. Significant interactions for caffeine dose by session on accuracy of response and latency of response indicated that caffeine enhanced the initial learning of a proprioceptive motor task but did not improve performance beyond that of normal practice.

Adolescent↗

PubMed1996

Symptomatic improvement in achalasia after botulinum toxin injection of the lower esophageal sphincter.

OBJECTIVES: The aim of this study was to assess the long term clinical outcome of patients with achalasia after treatment with botulinum toxin. METHODS: Sixty five patients with achalasia (60 idiopathic, five secondary) were treated with injection of botulinum toxin at the gastroesophageal junction. Dysphagia, chest pain, and regurgitation were scored (0 = no symptoms, 1 = mild, 2 = moderate, 3 = severe, 4 = very severe), with the sum representing the total symptom score, at 0, 7, 30, 120, 240, and 365 days posttreatment. Responders were defined as patients with a 50% decrease in total symptom score at 1 month posttreatment. RESULTS: The 60 patients with idiopathic achalasia had significant improvement in symptoms of dysphagia, chest pain, and regurgitation at 1 and 4 wk posttreatment. At 1 month posttreatment, 42 of 60 patients (70%) were classified as responders. Of 33 patients with at least 1 yr follow-up, 36% continued to have a good or excellent response, whereas 39% underwent a subsequent treatment with botulinum toxin, pneumatic dilation, or myotomy. When symptoms recurred after an initial response, patients responded to a second injection of botulinum toxin in six of seven cases. In four of five patients with secondary achalasia, there was no response to botulinum toxin. CONCLUSIONS: Botulinum toxin injection at the gastroesophageal junction significantly improved symptoms in 70% of patients with idiopathic achalasia at 1 month. Recurrent symptoms responded to repeat botulinum toxin treatment in initially responsive patients. In contrast, most patients with secondary achalasia did not improve after botulinum toxin injection.

Anti-Dyskinesia Agents↗

PubMed1995

Prevention of depression with primary care patients: a randomized controlled trial.

The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasible, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.

Adolescent↗

PubMed1995

Correlation of high-frequency esophageal ultrasonography and manometry in the study of esophageal motility.

BACKGROUND & AIMS: No studies correlate manometric measurements with morphological changes during the esophageal peristaltic sequence. The aim of this study was to develop and use a system for sonographically imaging the esophageal wall while simultaneously recording esophageal pressure changes. METHODS: An ultrasonography transducer attached to a manometric probe was used to evaluate the esophagus. RESULTS: Four sonographic phases of an esophageal peristaltic sequence were identified. The esophageal lumen was not open at rest in phase 1 (resting), increased to a maximum mean circumference of 4.90 +/- 0.57 cm in phase 2 (passive distention), and returned to a closed position in phases 3 (contraction) and 4 (relaxation). The muscle layers of the esophageal wall were baseline resting width in phase 1, decreased in width during phase 2, increased and reached maximum mean widths during phase 3, and returned to baseline widths during phase 4. The measurement of esophageal intraluminal pressure remained at a baseline resting level during phases 1 and 2, increased to a maximum mean peak of 67.95 +/- 9.18 mm Hg during phase 3, and returned to baseline during phase 4. CONCLUSIONS: A combined ultrasonography transducer/manometry probe was used to dynamically and simultaneously evaluate esophageal wall motion, muscle thickness, and esophageal pressure changes during peristalsis.

Adult↗

PubMed1995

Caffeine and time of day effects on a force discrimination task in humans.

The effects of caffeine (0 mg/kg, 1 mg/kg, 3 mg/kg) and time of day (TOD) on human performance were studied using a multiple forceband discrimination task (MFDT) and subjective ratings. Self-rated measures of energy level were affected by TOD and caffeine, while mood was affected by TOD. Energy level decreased throughout the day and was offset by caffeine which increased energy level independent of TOD. Self-reported anxiety was not affected by TOD or caffeine. Mood was affected by TOD in a complex cubic trend with late morning and late evening peaks 12 h apart. MFDT performance was affected by TOD, caffeine dosage, and their interaction. Trend analyses showed varying patterns of TOD effects across peak force variability, response latency, response duration, and correct responding. Results support and extend previous findings of TOD influences on the MFDT and support the utility of multicomponent proprioceptive tasks for examining drug effects on performance.

Adult↗

PubMed1995

High-resolution endoluminal sonography in achalasia.

BACKGROUND: Imaging of the lower esophageal sphincter in patients with achalasia using 7.5 and 12 MHz ultrasound transducers has shown variable results. METHODS: A 20 MHz radial ultrasound transducer was used to quantitatively compare the lower esophageal sphincter in patients with achalasia to that of normal volunteers. The transducer, housed in a 6.2F catheter, was placed at the level of the lower esophageal sphincter in 29 patients with achalasia and 19 normal subjects. Videotaped images from the lower esophageal sphincter were digitized and the width of the circular smooth muscle, longitudinal smooth muscle, and total muscularis propria were measured. A mean width for each muscle layer was calculated. RESULTS: All muscle layers were found to be significantly thickened at the lower esophageal sphincter in patients with achalasia when compared with those in normal subjects: circular smooth muscle (0.206 cm +/- 0.137 cm vs 0.124 cm +/- 0.038 cm, p < 0.017); longitudinal smooth muscle (0.128 cm +/- 0.077 cm vs 0.088 cm +/- 0.028 cm, p < .041); and total muscle thickness (0.317 +/- 0.180 cm vs 0.224 cm +/- 0.049 cm, p < 0.033). CONCLUSION: Although high-resolution endoluminal sonography cannot be used to differentiate patients with achalasia from normal controls, this study quantitatively demonstrates that both the mean longitudinal and mean circular smooth muscle layers at the lower esophageal sphincter are wider in patients with achalasia than in a group of normal subjects.

Adult↗

PubMed1995

Evaluation of asymptomatic microhematuria.

OBJECTIVES: The purpose of this study was to evaluate a comprehensive urine cytodiagnostic assay to assist in localizing the site of origin and the etiology of asymptomatic microhematuria. This analysis, which assesses various qualitative and quantitative aspects of the voided urine, is compared simultaneously with controls obtained from the established routine urologic evaluation. METHODS: One hundred consecutive subjects who presented solely for the evaluation of asymptomatic microhematuria were evaluated by the established routine urologic evaluation and a refined urine cytodiagnostic assay. For the purpose of this study, only calculi and neoplasms were considered significant findings. RESULTS: The incidence of significant urologic disease was 13% (3 renal neoplasms, 2 urothelial bladder carcinomas, and 8 urinary calculi). The refined urine cytodiagnostic assay identified both uroepithelial vesical neoplasms, 7 of the 8 urinary calculi, and none of the 3 renal neoplasms. The presence of dysmorphic urinary red blood cells (RBCs) and RBC casts was strongly suggestive of renal parenchymal bleeding. Overall, 43 of 44 subjects (98%) with dysmorphic RBCs and RBC casts failed to demonstrate any significant urologic etiology. CONCLUSIONS: These preliminary results suggest that the refined cytodiagnostic urine assay may be helpful in distinguishing whether a given patient's microhematuria is of a significant urologic or a renal parenchymal cause. The addition of this specialized urinalysis may prove a useful adjunct in improving the diagnostic yield in patients with asymptomatic microhematuria.

Adolescent↗

PubMed1995

The New York Teacher Rating Scale for disruptive and antisocial behavior.

OBJECTIVE: A teacher rating scale designed to reflect current diagnostic descriptors of oppositional defiant disorder and conduct disorder was developed and standardized. METHOD: Teacher ratings were obtained for 1,258 1st-through 10th-grade children from two school districts in New York and for 81 clinically referred children with conduct disorder. RESULTS: Three factors relevant to oppositional defiant disorder and conduct disorder were generated: defiance, physical aggression, and delinquent aggression. A fourth factor reflects peer problems. Internal consistency, test-retest reliability, and interrater reliability are documented using a population and a conduct disorder sample. The validity of the factors is supported by the factors' ability to discriminate between children in the general population and those with conduct disorders, by correlations with global impairment items, and by expected sex differences. CONCLUSION: The scale has utility for assessing symptoms of conduct disorder in school settings.

Adolescent↗

PubMed1995

Gender differences in schizotypic features in a large sample of young adults.

Research with self-report measures of schizotypic or psychosis-prone features in nonclinical populations suggests that, similarly to schizophrenic populations, males score higher on more "negative" schizotypic features and females score higher on more "positive" schizotypic features. We administered the Schizotypal Personality Questionnaire and the Chapman Scales of Psychosis Proneness--impulsivity/nonconformity, magical ideation, perceptual aberration, physical anhedonia, and social anhedonia--to a large, nonclinical, young adult sample (N = 1179: 453 males and 726 females). Results indicated increased negative symptomatology in males compared with females, but not increased positive symptomatology in females compared with males. Findings on Schizotypal Personality Questionnaire factors suggested that interpersonal deficits differed by gender as well. Finally, a measure of impulsive behavior and nonconformity not typically associated with negative symptomatology indicated gender differences not predicted by a negative/positive dichotomy.

Adolescent↗

PubMed1995

Reactive oxidants mediate TNF-alpha-induced leukocyte adhesion to rat mesenteric venular endothelium.

We investigated the role of reactive oxygen metabolites (ROMs) as potential mediators of tumor necrosis factor-alpha (TNF-alpha)-stimulated neutrophil adhesion to rat mesenteric venules in vivo, using intravital microscopy and fixed whole mount preparations of mesentery. Intraperitoneal injection of TNF-alpha significantly increased leukocyte rolling, adhesion, and emigration in a dose- and time-dependent manner. Leukocyte adhesion and emigration, but not rolling, were significantly attenuated by prior intravenous administration of monoclonal anti-intercellular adhesion molecule-1 (ICAM-1). Rolling leukocyte flux was significantly attenuated by intravenous preadministration of superoxide dismutase (SOD), catalase, or both. Only catalase or SOD plus catalase significantly inhibited leukocyte adhesion. Catalase alone inhibited emigration. Moreover, postadhesive treatment with catalase but not SOD, 4 h after TNF-alpha administration reduced the flux of rolling (but not adherent) leukocytes that had previously increased in response to TNF-alpha. Intragastric allopurinol (50 mg/kg at 3 and 18 h before TNF-alpha administration) or 3 wk of a tungsten-enriched diet substantially inhibited xanthine oxidase activity but had no significant effects on the above parameters of neutrophil dynamics. In parallel experiments using fixed whole mount preparations of the mesoappendix stained specifically for neutrophil esterase, neutrophil adhesion 2 h after TNF-alpha administration was also inhibited by continuous intravenous administration of catalase but not by SOD, intragastric allopurinol, or tungsten diet. These findings suggest that ROMs, apparently not from xanthine oxidase, are important mediators of TNF-alpha-induced upregulation of neutrophil adhesion in rat mesenteric venules.

Allopurinol↗

PubMed1995

Agencies & vendors. Friends, foes, or partners?

Communication is the key to making vendor-agency relationships work. This communication needs to start from the very beginning, with planning, and continue through installation, training, and support. With good communication, the change brought on by automation will be positive.

Ambulatory Care Information Systems↗

PubMed1995

The use of high frequency endoscopic ultrasonography probes in the evaluation of achalasia.

Because its ultrasound beam cannot penetrate beyond a radius of 2 cm, HRES is limited in evaluating abnormalities within or adjacent to the esophageal wall. To date, however, it has provided new diagnostic capabilities in evaluating patients with several different esophageal disorders. EUS at lower frequencies has shown inconsistent results in evaluating the thickness of esophageal muscle layers in patients with achalasia. HRES has been able to more accurately measure the individual CSM, LSM, and TM layers of the muscularis propria and the mean measurements have been noted to increase in achalasia patients when compared with normals. HRES has been found to be clinically useful in assessing histologic damage following pneumatic dilatation and in localizing the LES during the administration of intrasphincter botulinum toxin injection in the treatment of achalasia.

Endoscopy, Digestive System↗

PubMed1995

The economic burden of affective disorders.

BACKGROUND: This paper summarises the methods and sources of data used to estimate costs of affective disorders and presents the results. METHOD: A timing model employing regression analysis was developed to estimate morbidity costs. This model measures the lifetime effect on current income of individuals with affective disorders, taking into account the timing of onset and the duration of these disorders. RESULTS: Affective disorders imposed an estimated US$ 20.8 billion burden in 1985 and US$ 30.4 billion in 1990 in the US. Affective disorders represent 21% of the costs of all mental illnesses. Direct treatment costs comprised 58.4% of the total in 1985; morbidity costs, 8.1%; mortality costs, the present value of future earnings lost due to premature mortality, 28.9%, based on a 6% discount rate; and other related costs, including the cost of crime, lost productivity due to incarceration, and caregiver services, 4.6%. Private sources account for 49% of the total direct expenditures for treatment of persons with affective disorders; state and local funds, 26%; and federal funds, 25%. CONCLUSION: In light of the high burden of affective disorders on societal resources, more attention should be directed at comprehensive, research-based strategies to reduce the prevalence of these disorders in the United States.

Adolescent↗

PubMed1994

Variation in practice for discretionary admissions. Impact on estimates of quality of hospital care.

OBJECTIVE: To demonstrate theoretically and empirically the existence of systematic bias in commonly reported standardized hospital mortality ratios when variation in hospital admission practice is not adjusted for in the analysis. The underlying analytic model used in hospital mortality analyses is specified and the confounding effect of selection bias arising from variation in admission practice is shown. DATA SOURCES: An empirical example is presented using state-level data from the Health Care Financing Administration's Medicare Hospital Information Report for 1988 to 1990. STUDY SELECTION: The Medicare Hospital Information data are used to demonstrate the effects of the bias because they contain population-based admission rates and mortality rates. DATA SYNTHESIS: Selection bias arising from variation in admission practice causes the expected mortality rate to be overestimated for all hospitals, but especially for hospitals with more lenient admission practices. Using the Medicare Hospital Information Report, the resulting standardized hospital mortality ratios are shown to be significantly inversely correlated with higher relative risks of hospitalization (P < .01). CONCLUSION: Standardized hospital mortality ratios based on analyses that do not account for variation in admission practice among hospitals are biased. Variation in admission practice will cause any outcome measure based solely on hospitalized patients to be similarly biased. Correction for selection bias is required to produce valid measures of hospital quality.

Bias↗

PubMed1994

Primary prevention of conduct disorder.

Conduct disorders represent one of the most troubling and persistent childhood psychiatric disorders. This serious condition has a poor long-term prognosis and entails a wide range of negative consequences over the life span. No single intervention strategy has been identified that successfully alters its negative course. This article reviews developmental findings and previous intervention efforts and provides a rationale for approaching the problem of Conduct Disorder through primary preventive intervention. A comprehensive, family-based prevention model and specific clinical strategies for intervention are described. A case example is used to illustrate the integration of program components.

Antisocial Personality Disorder↗

PubMed1994

Correlations between akathisia and residual psychopathology: a by-product of neuroleptic-induced dysphoria.

Patients developing neuroleptic-induced akathisia have been reported to show higher levels of psychopathology. We sought to replicate this finding and determine its symptom specificity. We confirmed a significant relationship between ratings of akathisia and total score on the Brief Psychiatric Rating Scale (BPRS) during both acute and maintenance neuroleptic treatment. Using stepwise regression models, BPRS anxious-depressive subscale scores were the strongest predictors of akathisia during both treatment conditions. Paranoid subscale scores predicted akathisia only during maintenance treatment. These results suggest that neuroleptic-induced dysphoria largely explains the relationship between akathisia and residual psychopathology during both acute and maintenance neuroleptic treatment.

Adult↗

PubMed1994

High-resolution endoluminal sonography of the anal sphincter complex.

The ability of a high-frequency miniature ultrasonographic transducer to image the anatomy of the anal sphincter complex was investigated in 20 normal subjects. A 9 Fr catheter containing a 12.5 MHz transducer was inserted into the anal canal. Cross-sectional ultrasonographic images of the canal were acquired as the catheter was advanced through the canal into the distal rectum. Three analog images were digitally stored on a computer system, and measurements of the anal sphincters were made from an eight octant grid by two independent investigators. In all 20 subjects the hypoechoic mucosa, hyperechoic submucosa, and hypoechoic internal anal sphincter (IAS) were identified. The first band of the external anal sphincter (EAS) was imaged in 12 of 20 subjects. The mean width of the IAS was 3.5 +/- 0.5 mm (range, 2.6-4.3 mm). The mean width of the first band of the EAS was 2.3 +/- 0.5 mm (range, 1.6-3.2 mm). High-resolution sonography of the anal canal allows detailed evaluation of anatomic structures that cannot be achieved by conventional imaging technology.

Anal Canal↗