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Biomedical subjects

M A Cohen

Publications and source records attributed to M A Cohen.

At least 73 records · Page 4Linked to original sources

Neural control of interlimb oscillations. I. Human bimanual coordination.

How do humans and other animals accomplish coordinated movements? How are novel combinations of limb joints rapidly assembled into new behavioral units that move together in in-phase or anti-phase movement patterns during complex movement tasks? A neural central pattern generator (CPG) model simulates data from human bimanual coordination tasks. As in the data, anti-phase oscillations at low frequencies switch to in-phase oscillations at high frequencies, in-phase oscillations occur at both low and high frequencies, phase fluctuations occur at the anti-phase in-phase transition, a "seagull effect" of larger errors occurs at intermediate phases, and oscillations slip toward in-phase and anti-phase when driven at intermediate phases. These oscillations and bifurcations are emergent properties of the CPG model in response to volitional inputs. The CPG model is a version of the Ellias-Grossberg oscillator. Its neurons obey Hodgkin-Huxley type equations whose excitatory signals operate on a faster time scale than their inhibitory signals in a recurrent on-center off-surround anatomy. When an equal command or GO signal activates both model channels, the model CPG can generate both in-phase and anti-phase oscillations at different GO amplitudes. Phase transitions from either in-phase to anti-phase oscillations, or from anti-phase to in-phase oscillations, can occur in different parameter ranges, as the GO signal increases.

Extremities↗

Neural control of interlimb oscillations. II. Biped and quadruped gaits and bifurcations.

Behavioral data concerning animal and human gaits and gait transitions are simulated as emergent properties of a central pattern generator (CPG) model. The CPG model is a version of the Ellias-Grossberg oscillator. Its neurons obey Hodgkin-Huxley type equations whose excitatory signals operate on a faster time scale than their inhibitory signals in a recurrent on-center off-surround anatomy. A descending command or GO signal activates the gaits and triggers gait transitions as its amplitude increases. A single model CPG can generate both in-phase and anti-phase oscillations at different GO amplitudes. Phase transitions from either in-phase to anti-phase oscillations or from anti-phase to in-phase oscillations can occur in different parameter ranges, as the GO signal increases. Quadruped vertebrate gaits, including the amble, the walk, all three pairwise gaits (trot, pace, and gallop), and the pronk are simulated using this property. Rapid gait transitions are simulated in the order--walk, trot, pace, and gallop--that occurs in the cat, along with the observed increase in oscillation frequency. Precise control of quadruped gait switching uses GO-dependent modulation of inhibitory interactions, which generates a different functional anatomy at different arousal levels. The primary human gaits (the walk and the run) and elephant gaits (the amble and the walk) are simulated, without modulation, by oscillations with the same phase relationships but different waveform shapes at different GO signal levels, much as the duty cycles of the feet are longer in the walk than in the run. Relevant neural data from spinal cord, globus pallidus, and motor cortex, among other structures, are discussed.

Animals↗

Costs of gunshot and cut/stab wounds in the United States, with some Canadian comparisons.

This article estimates the costs of U.S. gunshot and cut/stab wound by intent. It also compares U.S. to Canadian gunshot experience. Incidence data are from published sources, the National Hospital Ambulatory Medical Care Survey (NHAMCS), and cause-coded emergency department discharge and hospital discharge data systems. Medical care payments and lost earnings per case come from National Crime Survey data, a literature review, and weighting of costs by diagnosis from Databook on Nonfatal Injury-Incidence. Costs, and Consequences by Miller et al. (The Urban Institute Press, Washington, DC. 1995) with the diagnosis distribution of penetrating injuries from the discharge data systems. Quality of life losses are estimated primarily from jury awards to penetrating injury victims. In 1992, gunshots killed 37,776 Americans; cut/stab wounds killed 4095. Another 134,000 gunshot survivors and 3,100,000 cut/stab wound survivors received medical treatment. Annually, gunshot wounds cost an estimated U.S. $126 billion. Cut/stab wounds cost another U.S. $51 billion. The gunshot and cut/stab totals include U.S. $40 billion and U.S. $13 billion respectively in medical, public services, and work-loss costs. Across medically treated cases, costs average U.S. $154,000 per gunshot survivor and U.S. $12,000 per cut/stab survivor. Gunshot wounds are more than three times as common in the U.S. than in Canada, which has strict handgun control. With the same quality of life loss per victim, gunshot costs per capita are an estimated U.S. $495 in the U.S. vs U.S. $180 in Canada. Per gun, however, the costs are higher in Canada, Gunshot wound rates rise linearly with gun ownership.

Canada↗

In-vitro activity of clinafloxacin, trovafloxacin, and ciprofloxacin.

Clinafloxacin and trovafloxacin are two new fluoroquinolones for which few comparative data are available. When MICs of ciprofloxacin against Gram-positive and Gram-negative nosocomial species were compared, clinafloxacin was the most potent although trovafloxacin was also more active than ciprofloxacin against Staphylococcus aureus and enterococci. All three drugs were bactericidal. Clinafloxacin displayed the lowest frequency of resistance, approximating 10(-11). Development of resistance studies over 13-14 passages in the presence of drug revealed a 32-fold increase in MIC of clinafloxacin against S. aureus compared with 512- and 1024-fold for trovafloxacin and ciprofloxacin respectively, although the three drugs were comparable against Enterococcus faecalis and the Gram-negative bacilli.

Anti-Infective Agents↗

Understanding the state variation in Medicare home health care. The impact of Medicaid program characteristics, state policy, and provider attributes.

OBJECTIVES: During the past 7 years there has been a significant increase in the use of the Medicare home health benefit. In this article, the authors document trends in the use of the benefit and develop multivariate models to identify the factors that explain state variation in its use. METHODS: To develop quantitative models, the authors collected state information on all variables for each of 3 years: 1991, 1992, and 1993. The authors chose to focus on those variables that had been found to be significant in other research as well as those that we posited would likely influence utilization. The authors tested similar sets of explanatory variables for each year of the analysis. The unit of analysis is the "state" and depending on data availability, the number of states included in the analyses range from between 46 to 49. (Arizona does not have a state Medicaid program.) RESULTS: The authors' analysis shows that interaction exists between state policies and use of the benefit. Utilization is higher in states that face greater fiscal pressure concerning their Medicaid budgets; the lack of state personal care programs increases Medicare use, and, when Medicaid home health expenditures decline, the number of Medicare home health care users increases. There is also an inverse relationship between the number of long-term care and skilled nursing facilities in a state and the use of the benefit. Thus, for some, the benefit serves as a substitute for long-term care needs and, for others, for postacute care needs. CONCLUSIONS: The overlap between the population served and the services provided by state programs and Medicare has given states and providers an opportunity to leverage Federal dollars in lieu of state program dollars. As the Federal government attempts to control expenditure growth, policy-makers must be mindful of how state actions can influence the level and type of Federal expenditure.

Aged↗

Impact of core biopsy on the surgical management of impalpable breast cancer.

OBJECTIVE: The purpose of this study was to compare impalpable breast carcinomas revealed by core biopsy with those revealed by surgical biopsy with respect to the frequency of performing a single surgical procedure and finding tumor at the margins of the lumpectomy specimen. MATERIALS AND METHODS: Retrospective review found 197 solitary impalpable breast carcinomas revealed by core biopsy using a 14-gauge needle (n = 90) or surgical biopsy after needle localization (n = 107). Lumpectomy was the surgical treatment in 62 (69%) of the 90 cancers revealed by core biopsy and in 74 (69%) of the 107 cancers revealed by surgical biopsy. Records were reviewed to determine the number and type of surgeries performed on each patient and the histopathologic findings at surgery. Lumpectomy margins were considered positive if tumor was present at the inked margins of a lumpectomy performed as a separate procedure after the diagnostic biopsy. RESULTS: A single surgical procedure was performed 76 (84%) of the 90 patients who underwent core biopsy versus 31 (29%) of the 107 patients who underwent surgical biopsy. This difference was statistically significant (p < .00001). Tumor was present at the lumpectomy margins in five (8%) of the 62 cancers revealed by core biopsy versus four (5%) of the 74 cancers diagnosed by surgical biopsy. This difference was not statistically significant (p = .7). CONCLUSION: A single surgical procedure was performed significantly more often in patients in whom impalpable breast cancer was revealed by core biopsy. The likelihood of obtaining tumor-free margins at lumpectomy did not differ significantly for cancers revealed by either method. These data indicate that core biopsy provides the information necessary to plan surgical treatment and could decrease the number of surgical procedures required in patients with impalpable breast cancer.

Biopsy↗

Effects of a live yeast culture and enzymes on in vitro ruminal fermentation and milk production of dairy cows.

Live yeast culture (Saccharomyces cerevisiae) grew best on malt extract agar and required incubation under aerobic conditions to maximize the number of viable cells. In sterile, anaerobic ruminal fluid that had been supplemented with malt extract, yeast cells remained viable and metabolically active for up to 48 h, as indicated by the production of ethanol. A supplement containing live yeast and enzymes was fed twice daily with a diet of 50:50 (wt/wt) forage to concentrate (dry matter basis) to continuous fermentors inoculated with mixed ruminal microorganisms. The supplement had no effect on major fermentation acids or pH. After the last supplement with yeast was fed, numbers of yeast immediately decreased in the fermentors and were not detectable after 24 h. In the first of two lactation experiments, Holstein cows in midlactation were offered a diet with corn silage as the primary forage source. Half of the cows received a top-dressing based on corn that contained 10 g/d of the yeast and enzyme supplement. The supplement had no effect on milk production, milk composition, or dry matter intake. In a second lactation experiment, high producing cows in early lactation were fed 0, 10, and 20 g/d of the supplement. Cows fed the control diet produced 36.4 kg of milk/d, and milk production was 39.3 and 38.0 kg/d from cows fed 10 and 20 g of yeast/d, respectively.

Animal Feed↗

The changing face of long-term care insurance in 1994: profiles and innovations in a dynamic market.

This study examines buyers and nonbuyers of long-term care insurance. The findings show that consumers purchased more comprehensive products in 1994-95 than they did in 1990, and that they appeared to get better value for the premium dollar. While annual sales are increasing at a rate of 25%, the market for long-term care insurance remains small, and many of the market barriers that existed four to five years ago persist today. These include confusion about public coverage, concerns about the adequacy of products and how to choose them, policy cost, and inadequate information about potential risk for needing long-term care. As states target limited public funds toward the indigent, older middle-class people will have to deal with exposure to risk for long-term care, and insurance may be one way to minimize this exposure.

Age Factors↗

Does the BJGP need more fizz and pop?--A Midland Faculty readership survey.

BACKGROUND: The British Journal of General Practice (BJGP) is the leading primary care journal in the world. By impact factor, it ranks 24th of all medical journals. However, despite major changes in the journal since its inception in 1954, there have been no published readership surveys since a limited report in 1969. AIM: To canvass members of the Midland Faculty and to add to the debate about the future of the BJGP. METHOD: A postal questionnaire was sent to a random sample of 299 members, fellows and associates of the Midland Faculty asking for their views about the BJGP. RESULTS: Two hundred replies were received (a response rate of 67%). The median year of qualification of responders was 1981, and 32 (16%) held academic posts. Ninety-nine (49%) disagreed with the present format of the BJGP, which compared poorly with the British Medical Journal (BMJ) in simple rank order of importance. Readership was equal to that of the BMJ (93% reading it within 28 days of arrival), but fewer people read it within a week of receiving it. The most popular sections were the editorials, original articles and letters; least popular were the book reviews and the pull-out magazine, Connection. All sections were rated excellent to average. Readers wished for an expansion of the BJGP to include clinical reviews, medical politics and humorous pieces. Most responders felt that Connection should remain separate. There was dissatisfaction with the delay between submission and publication of original articles, particularly among the academic general practitioners (GPs). Academics and fundholders did not differ from other readers in their views of the content or style of the BJGP. Half of the responders stated that the BJGP should be self-financing and should be open to more advertising. Responders' free comments largely related to improving the style of articles and expanding the BJGP. CONCLUSION: There is a view that the present BJGP is not relevant to the non-academic GP. This is probably due to style rather than content. Simple comparisons with a weekly multi-disciplinary journal may not be valid. The style could be updated to improve retention of information and to highlight areas of particular relevance. Readers are satisfied with the core content of the BJGP but want it to expand to include humour, clinical reviews and medical politics, for example. There is no evidence that the BJGP is more appealing to the academic GP. This study supports an expanded BJGP with an improved style.

Data Collection↗

Androgen-induced proliferation in the developing larynx of Xenopus laevis is regulated by thyroid hormone.

Exposure to exogenous androgen regulates cell number in the developing larynx of Xenopus laevis and hormone-regulated laryngeal development requires secretion of thyroid hormone (TH). We sought to determine whether exposure to TH is both sufficient and necessary for androgen-evoked cell proliferation (androgen competency) in developing larynx. Androgen competency was not observed in the premetamorphic larynx (tadpole stage 53, before TH secretion) but was present just prior to metamorphic climax (stage 58, during TH secretion). However, when TH is administered precociously (between stages 48 and 50), androgen competency can be observed at stage 53. The stage 52 larynx expresses high levels of the mRNA for TH receptor alpha. The duration of TH exposure required at tadpole stage 48 is greater than 2 days; studies in juveniles indicate that TH exposure need not be maintained in order for androgen competency to persist. The effects of exposure to TH on androgen competency are long lasting and perhaps permanent. While organotypic cultures obtained from tadpoles during premetamorphosis (stage 52) can proliferate in vitro and proliferation is augmented by TH exposure as it is in vivo, precocious exposure to TH does not induce androgen competency. In contrast, androgen does evoke cell proliferation in cultures obtained from metamorphosing (stage 58) tadpoles; proliferation is confined to the cartilage component. Thus, unlike larynges in vivo, muscle will not proliferate in response to androgen, indicating the necessity for an additional factor not present in vitro. Androgen receptor mRNA expression, believed required for androgen competency, was assessed in vivo and in vitro. The tadpole larynx strongly expresses AR mRNA, expression does not require exposure to TH nor is expression diminished in culture.

Animals↗

Androgen receptor mRNA expression in Xenopus laevis CNS: sexual dimorphism and regulation in laryngeal motor nucleus.

Using Northern analysis, in situ hybridization, and nuclease protection assays, the expression and regulation of androgen receptor messenger RNA (AR mRNA) was examined in the CNS of juvenile Xenopus laevis. Only one of the AR mRNA isoforms expressed in X. laevis is transcribed in the CNS as shown by Northern blot analysis. Nuclease protection assays demonstrate that the expression of AR mRNA is higher in the brain stem than in the telencephalon and diencephalon. Although expression of AR mRNA is widespread throughout the CNS, cells of cranial nerve nucleus IX-X (N.IX-X) and spinal cord display the highest in situ hybridization signals in their cytoplasm. Double labeling using horseradish peroxidase and digoxigenin labeled AR probes reveals that laryngeal and anterior spinal cord motor neurons express AR mRNA. More cells express AR mRNA in N.IX-X of males than of females. The number of AR expressing cells in N. IX-X decreases following gonadectomy in both sexes, and dihydrotestosterone (DHT) treatment for 1 month reverses this effect. Increased expression of AR mRNA in the brain of DHT treated animals is also apparent in nuclease protection assays. Sex differences in number of AR expressing cells and hormone regulation of AR mRNA expression in motor nuclei may influence neuromuscular systems devoted to sexually differentiated behaviors.

Animals↗

Sparfloxacin worldwide in vitro literature: isolate data available through 1994.

Sparfloxacin is a piperazinyl, cyclopropyl-fluoroquinolone with broad-spectrum antibacterial activity. Compared to other quinolones, sparfloxacin displays improved activity against a variety of pathogens including Staphylococcus, Streptococcus, Enterococcus, Chlamydia, Mycoplasma, Ureaplasma, and Mycobacteria species. Other susceptible organism group include Haemophilus, Legionella, Moraxella, Neisseria, Aeromonas, Acinetobacter, Bordetella, Brucella, Campylobacter, Gardnerella, and Helicobacter species. Most Enterobacteriaceae are also susceptible, whereas most isolates of Pseudomonas aeruginosa are not. Sparfloxacin is bactericidal. Activity is generally stable to variations of inoculum, pH, and cation concentration, and it is unchanged in the presence of 5% sodium cholate or 70% human serum. Susceptibility to the drug is diminished in urine. Cross-resistance, although incomplete, has been documented with other quinolones, but not with other antimicrobic classes.

Anti-Infective Agents↗

Pseudoangiomatous stromal hyperplasia: mammographic, sonographic, and clinical patterns.

PURPOSE: To analyze the mammographic, ultrasonographic (US), and clinical patterns of pseudoangiomatous stromal hyperplasia (PASH). MATERIALS AND METHODS: Preoperative mammographic and US images, clinical records, and histologic assessments were reviewed in seven cases of PASH as the sole component or dominant stromal component of a clinically or mammographically defined mass lesion. In five, a PASH tumor was diagnosed at image-guided 14-gauge core-needle biopsy; in two, it was diagnosed at surgical excisional biopsy. RESULTS: Four women were premenopausal, two were postmenopausal, and one 40-year-old patient had iatrogenic primary amenorrhea. Four of seven masses were palpable; three were discovered at mammography. Four masses enlarged over 6 months to 5 years. At mammography, all masses lacked calcifications; six were well defined, and one was spiculated. One was inapparent at US; the remaining six were well defined and hypoechoic. CONCLUSION: The diagnosis of this rare lesion with image-guided breast biopsy or surgical biopsy is consistent with a well-defined uncalcified mass at mammography and a solid hypoechoic mass at US, usually in a premenopausal woman.

Adult↗

Benign and malignant phyllodes tumors: mammographic and sonographic findings.

PURPOSE: To characterize imaging findings that suggest the benign or malignant histologic nature of phyllodes tumors. MATERIALS AND METHODS: Clinical and imaging findings were retrospectively reviewed in 46 women with 51 phyllodes tumors (32 benign, 19 malignant) identified at preoperative mammography. Thirty of these tumors were also evaluated with preoperative sonography. RESULTS: Mammography showed nonspiculated soft-tissue masses in 49 tumors. Four masses contained calcifications; three of these masses were benign. The tumors were 1-20 cm in diameter; tumors 3 cm or larger were statistically significantly more likely to be malignant (P < .004). Sonography showed solid, hypoechoic masses in 28 cases. At sonography, cystic areas were more often seen in malignant than in benign tumors, but the difference was not statistically significant. CONCLUSION: There is substantial overlap in the imaging characteristics of benign and malignant phyllodes tumors. A tumor diameter of 3 cm or greater appears to be associated with a higher likelihood of malignancy.

Adult↗

Power injection of intravenous contrast material through central venous catheters for CT: in vitro evaluation.

PURPOSE: To determine the feasibility of use of a power injector to deliver contrast material through central venous catheters for computed tomographic (CT) examinations. MATERIALS AND METHODS: Ioversol 240 and iothalamate meglumine 43% were separately injected through three 9.6-F Hickman catheters and three 10.0-F Leonard catheters with a power injector in an in vitro study. Flow rates of 1.0, 1.5, 2.0, and 2.5 mL/sec were tested. Peak pressures were mechanically recorded from two sites. A 95% prediction interval was calculated for each peak pressure, and the upper limits at the prediction interval were evaluated to determine if it was less than the recommended limit of 25 psi (175 kPa). RESULTS: Contrast medium, flow rate, and catheter type each statistically significantly affected the measured peak pressures (P = .0001). For each flow rate tested, the upper limits of the prediction interval for the peak pressure at the connection between the coiled tubing and the catheter were below the manufacturer's specified peak pressure. CONCLUSION: In vitro analysis demonstrates that power injection of intravenous contrast medium through central venous catheters does not exceed the pressure limits of these catheters at the flow rates tested. In vivo testing to evaluate the safety and efficacy of power injection through central venous catheters is necessary.

Analysis of Variance↗

Core needle biopsy of synchronous ipsilateral breast lesions: impact on treatment.

OBJECTIVE: The purpose of this study was to evaluate the role of core biopsy in the diagnosis of multiple synchronous ipsilateral breast lesions and to determine the impact of this information on patients' management. MATERIALS AND METHODS: Of 371 patients who underwent core-needle breast biopsy under stereotaxic (n = 278) or sonographic (n = 93) guidance, 20 (5%) underwent core biopsy of two mammographically separate lesions in the ipsilateral breast on the same date. Fourteen of these 20 patients subsequently underwent surgery. We retrospectively reviewed the medical, radiographic, and histopathologic records in these 14 patients and in 91 patients with single mammographic lesions diagnosed as carcinoma by means of core biopsy during the same period. RESULTS: In 11 patients, core biopsy revealed two sites of carcinoma. Core biopsy findings in these 11 patients were two areas of infiltrating ductal carcinoma (n = 5), one infiltrating ductal carcinoma and one infiltrating lobular carcinoma (n = 2), one infiltrating ductal carcinoma and one ductal carcinoma in situ (n = 1), and two foci of ductal carcinoma in situ (n = 3). All 11 patients with two core biopsy-proven foci of carcinoma underwent mastectomy. Patients were significantly more likely to be treated with mastectomy if core biopsy revealed two rather than one site of carcinoma (100% versus 38%, p < .001). CONCLUSION: Core-needle biopsy is useful in diagnosing multiple synchronous ipsilateral breast lesions. By showing whether carcinoma is present in one or more sites in the breast, core biopsy can provide information of critical importance in making treatment decisions.

Adult↗