Search PubMed⌕ Search

Biomedical subjects

M Harris

Publications and source records attributed to M Harris.

At least 217 records · Page 12Linked to original sources
PubMed1997

Staphylococcus epidermidis produces a cell-associated proteinaceous fraction which causes bone resorption by a prostanoid-independent mechanism: relevance to the treatment of infected orthopaedic implants.

Staphylococcus epidermidis is the most commonly isolated coagulase-negative staphylococcus from the skin, gut and upper respiratory tract. Although it is less virulent than Staphylococcus aureus, it has emerged in recent years as an important causative agent of infections associated with metal implants, prosthetic devices and i.v. lines. We have previously demonstrated that a saline wash of S. aureus contained proteins which had potent bone-resorbing activity in vitro. The purpose of this study was to determine whether gently washing S. epidermidis in saline also released osteolytically active proteins. The so-called surface-associated material (SAM) eluted from S. epidermidis in saline was able to induce osteolysis, and activity was heat and trypsin sensitive, suggesting that the active component was proteinaceous. Fractionation studies have suggested that activity is due to a small number of cationic proteins. This SAM-induced bone resorption was not inhibited by the cyclo-oxygenase inhibitor, indomethacin, or the 5-lipoxygenase inhibitors BWA70C and MK886. However, it was partially inhibited by high concentrations of interleukin-1 receptor antagonist and was completely blocked by a neutralizing antibody to tumour necrosis factor-alpha. Thus, the SAM from this organism is a potent osteolytic agent which differs from that of S. aureus SAM in not being inhibited by cyclo-oxygenase inhibitors. As adjunctive therapy is becoming necessary in infectious diseases, either as a result of the side-effects of antibiotics or their lack of efficacy, consideration should be given to the future treatment of bone infections with staphylococci in the light of the different mechanisms of action of the surface proteins produced by these bacteria.

Animals↗
PubMed1997

Integrated treatment for dually diagnosed homeless adults.

This study examined the effects of integrating mental health, substance abuse, and housing interventions for homeless persons with co-occurring severe mental illness and substance use disorder. With the use of a quasi-experimental design, integrated treatment was compared with standard treatment for 217 homeless, dually diagnosed adults over an 18-month period. The integrated treatment group had fewer institutional days and more days in stable housing, made more progress toward recovery from substance abuse, and showed greater improvement of alcohol use disorders than the standard treatment group. Abuse of drugs other than alcohol (primarily cocaine) improved similarly for both groups. Secondary outcomes, such as psychiatric symptoms, functional status, and quality of life, also improved for both groups, with minimal group differences favoring integrated treatment.

Adolescent↗
PubMed1997

An STS-based radiation hybrid map of the human genome.

We have constructed a physical map of the human genome by using a panel of 83 whole genome radiation hybrids (the Stanford G3 panel) in conjunction with 10,478 sequence-tagged sites (STSs) derived from random genomic DNA sequences, previously mapped genetic markers, and expressed sequences. Of these STSs, 5049 are framework markers that fall into 1766 high-confidence bins. An additional 945 STSs are indistinguishable in their map location from one or more of the framework markers. These 5994 mapped STSs have an average spacing of 500 kb. An additional 4484 STSs are positioned with respect to the framework markers. Comparison of the orders of markers on this map with orders derived from independent meiotic and YAC STS-content maps indicates that the error rate in defining high-confidence bins is < 5%. Analysis of 322 random cDNAs indicates that the map covers the vast majority of the human genome. This STS-based radiation hybrid map of the human genome brings us one step closer to the goal of a physical map containing 30,000 unique ordered landmarks with an average marker spacing of 100 kb.

Animals↗
PubMed1997

Violence against women: an education program for rural community health workers.

This study aimed to identify the educational needs of community-based rural health professionals regarding violence against women, and was funded under the Rural Health Support, Education and Training (RHSET) program. Focus groups and teleconferences were conducted with health workers, organisations and key individuals in the Wide Bay Region, Queensland, Australia. As a result, an education package has been designed that will provide specific training in violence against women for rural and remote health professionals working in the field. Rural health community workers identified the need to enhance their intervention skills and understanding on the issue of violence against women. A distance education framework based on adult and guided learning principles has been developed to meet this need. Six areas were identified as important learning needs and included: (i) violence against women as a public health concern; (ii) The role of the community health worker; (iii) How the community health worker can empower women experiencing violence in their lives; (iv) Enhancing and developing supportive networks; (v) Building on community development action; and (vi) 'Where to next' for community health workers.

Adult↗
PubMed1997

An immunohistochemical study of oral submucous fibrosis.

Oral submucous fibrosis (OSF) is a chronic disease of the oral cavity characterized by inflammation and progressive mucosal fibrosis. These reactions may be the result of either direct stimulation from exogenous antigens like areca alkaloids or by changes in tissue antigenicity that may lead to an autoimmune response. This study investigated the presence and distribution of inflammatory cells and MHC class II antigen expression by epithelial and immunocompetent cells using a three-stage immunoperoxidase method on frozen sections. Thirty OSF tissue specimens and ten normal buccal mucosae were studied and compared. All tissues were investigated using antibodies to T cells (CD3), T helper/inducer cells (CD4), T suppressor/ cytotoxic cells (CD8), B cells (CD20), naive T cells and monocytes (CD45RA), macrophages, Langerhans' cells (CD68) and HLA-DR-positive cells (HLA-DR alpha). The predominant cell populations detected in normal tissues were CD3, CD4 and HLA-DR-positive cells. The distribution of CD4-positive cells was similar to that of CD3-positive cells, which were scattered, often uniformly distributed, both in the epithelium and connective tissue. CD8-positive cells were occasionally seen in the normal epithelium and lamina propria. Few scattered B cells (CD20) and macrophages (CD68) were observed in normal mucosa. Naive T cells (CD45RA) were seen in all normal tissues focally concentrated around the connective tissue papillae, with a similar distribution to that of CD3-positive cells. All normal sections showed HLA-DR-positive cells scattered both in the epithelium and in the lamina propria. Epithelial cells did not show any positive reaction to this antibody and many intraepithelial positive cells showed a dendritic morphology. The cell population detected in OSF showed higher numbers of CD3 and HLA-DR-positive cells compared with those of the normal tissues. The pattern of staining for CD4-positive cells in OSF tissues was similar to that of CD3-positive cells both in the epithelium and connective tissue and was higher than that in normal tissues. A few scattered CD8-positive cells and only occasional CD20- and CD68-positive cells were seen in OSF sections. Few CD45RA-positive cells were found in the epithelium and lamina propria of OSF sections. However, OSF specimens showed high numbers of HLA-DR-positive cells in the basal layer of the epithelium, juxtaepithelium and in the lamina propria in a similar distribution to that of CD3 cells compared with the normal tissues. Most HLA-DR-positive cells in the epithelium showed dendrites directed vertically towards the surface. The increased evidence of CD4 and HLA-DR-positive cells in OSF tissues suggests that most lymphocytes were activated and shows an increased presence of Langerhans' cells. The presence of these immunocompetent cells and high ratio of CD4 to CD8 in OSF tissues suggest an ongoing cellular immune response leading to a possible imbalance of immunoregulation and alteration in local tissue architecture.

Adolescent↗
PubMed1997

Housing status among formerly homeless dually diagnosed adults.

OBJECTIVE: Residential outcomes of homeless adults with severe mental illness and a substance use disorder were studied over 18 months during which participants received integrated dual diagnosis services and housing supports based on a continuum model. METHODS: Interviews with 158 participants at baseline and at six-, 12-, and 18-month follow-ups assessed housing status, residential history, substance abuse and progress toward recovery, psychiatric symptoms, and quality of life. Complete data were available for 122 participants. If participants lived continuously in high-quality housing with no housing loss or nights of homelessness during the final six months of the study, they were classified as having stable housing. RESULTS: Of the 122 participants for whom complete data were available, 64 (52 percent) achieved stable housing. Most participants who achieved stable housing first entered staffed and supervised housing and then moved to independent arrangements by the end of the study. Stable housing during the final evaluation period was associated with lower substance use, greater progress toward substance abuse recovery, and higher quality of life. Final housing status was not predicted by baseline variables but was predicted by progress toward recovery during months 0 to 6 and 6 to 12 and by less severe drug use during months 6 to 12. Participants who abused no illicit drugs during months 6 to 12 were almost three times as likely to achieve stable housing as those who abused illicit drugs. CONCLUSIONS: Housing stability is strongly mediated by substance abuse and progress toward recovery. Nevertheless, when formerly homeless persons with dual diagnoses are provided integrated dual diagnosis treatment, they can gradually achieve stable housing.

Adult↗
PubMed1997

Model of complications of NIDDM. I. Model construction and assumptions.

OBJECTIVE: To develop a model of NIDDM for analyzing prevention strategies for NIDDM. RESEARCH DESIGN AND METHODS: A Markov type model with Monte Carlo techniques was used. Age, sex, and ethnicity of cohort was based on U.S. data. Incidence rates of complications were also based on community and population studies. RESULTS: Nonproliferative retinopathy, proliferative retinopathy, and macular edema are predicted in 79, 19, and 52%, respectively, of people with NIDDM; 19% are predicted to develop legal blindness. Microalbuminuria, gross proteinuria, and end-stage renal disease related to diabetes are predicted in 53, 40, and 17%, respectively. Symptomatic sensorimotor neuropathy and lower-extremity amputation are predicted in 31 and 17%, respectively. Cardiovascular disease is predicted in 39%. Higher rates of complications (1.1-3.0x) are predicted in minority populations. Predicted average life expectancy is 17 years after diagnosis. CONCLUSIONS: A probabilistic model of NIDDM predicts the vascular complications of NIDDM in a cohort representative of the incident cases of diabetes in the U.S. before age 75 years. Predictions of complications and mortality are consistent with the known epidemiology of NIDDM. The model is suitable for evaluating the effect of preventive interventions on the natural history of NIDDM.

Adult↗
PubMed1997

Model of complications of NIDDM. II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia.

OBJECTIVE: To analyze the health benefits and economics of treating NIDDM with the goal of normoglycemia. RESEARCH DESIGN AND METHODS: Incidence-based simulation model of NIDDM was used. Hazard rates for complications were adjusted for glycemia using risk gradients from the Diabetes Control and Complications Trial. Treatment costs were estimated from national survey data and clinical trials. Incremental costs and benefits were expressed in present value dollars (3% discount rate). Life-years were adjusted for quality of life, yielding quality-adjusted life-years (QALYs). RESULTS: Comprehensive treatment of NIDDM that maintains an HbA1c value of 7.2% is predicted to reduce the cumulative incidence of blindness, end-stage renal disease, and lower-extremity amputation by 72, 87, and 67%, respectively. Cardiovascular disease risk increased by 3% (no effect of treating glycemia is assumed). Life expectancy increased 1.39 years. The cost of treating hyperglycemia increased by almost twofold, which is partially offset by reductions in the cost of complications. The estimated incremental cost/QALY gained is $16,002. Treatment is more cost-effective for those with longer glycemic exposure (earlier onset of diabetes), minorities, and those with higher HbA1c under standard care. CONCLUSIONS: The incremental effectiveness of treating NIDDM with the goal of normoglycemia is estimated to be approximately $16,000/QALY gained, which is in the range of interventions that are generally considered cost-effective.

Adult↗
PubMed1997

Closing the gap between what we know and what we do.

Too often, clinical investigators have identified techniques to improve patient care for certain conditions, but those techniques slowly find their way into practice. At the Institute for Healthcare Improvement, new methods that accelerate the implementation of improved clinical practices are being taught to participants in Breakthrough Series collaboratives. These methods have to do with testing change in small increments, based on "just enough" measurement; analyzing the results to ensure the change is an improvement; and moving on to the next small-scale change test. Several experts and participants talk about breakthroughs they've seen as a result of several incremental improvements. Using breakthrough methods, they've dealt with several clinical problems, resulting in improvements such as reduced emergency room delays and improved scheduling of i.v. therapy.

Clinical Protocols↗
PubMed1997

Designing for patient-centered care--making it happen in today's marketplace.

It's more than just "muffins and massage," Laura Gilpin says of the Planetree program. It's a new level of awareness of patients' concerns and needs. That level of awareness is carried to the patients' surroundings, calm, home-like and friendly to visitors. Caregivers at Griffin Hospital in Derby, Conn.; Mid-Columbia Medical Center in The Dalles, Ore.; and Bergan Mercy Medical Center in Omaha, Neb., tell of their experiences and their commitment to this more humanistic approach to patient care. And the cost can be little more than the cost of traditional care.

Capital Financing↗
PubMed1997

Designing today's hospital for the future.

About 8,000 visitors each day are treated to the serene beauty of a four-story, sky-lit atrium, decorated with maple and cherrywood walls, flowering plants, towering evergreens, two fountains, and river-patterned porcelain tile that flows along the entryway. This is the entrance to Genesys Regional Medical Center-Health Park in Grand Blanc, Mich., often mistaken for a hotel. When designing the new 379-bed inpatient hospital, Genesys envisioned a facility that reflected a peaceful, comforting, homelike setting for patients and visitors. This vision, inspired by the spiritual values of the Sisters of St. Joseph, the Genesys sponsors, is now a reality. Having a vision and making it happen, however, was no small undertaking, says author Mark Harris of Genesys Health System. The labor-intensive, evolutionary process took several years and thousands of people. In this article, Harris describes many of the building project considerations involved in designing a hospital of the future.

Architectural Accessibility↗
PubMed1997

Failure mechanisms of anatomic porous replacement I cementless total hip replacement.

The APR-I Hip System was designed for metaphyseal bone attachment by proximal patch porous coating and the acetabular component was a hemisphere fixed with screws. The results of 100 consecutive primary total hip arthroplasties performed with the APR-I were studied in patients still alive after an average of 6.7 years. The selection of hips for implantation of this hip system was limited to those patients in whom a satisfactory intraoperative fit could be obtained. This resulted in a distribution of patients such that 75% were younger than age 65 years and only 15% had osteoporotic bone. The revision rate was 16% with a mechanical failure rate of 11%. Seventy percent of hips had progressive loss of fixation. loss of femoral component fixation was correlated with younger patient age, higher patient activity level, metaphyseal fill of less than 90%, and increased polyethylene wear and osteolysis. Eighty-nine percent of hips maintained femoral neck contact with the porous coated collar. The acetabular component was well fixed in 97% of hips. The failure rate of the APR-I stem is unacceptably high and this stem is no longer used by the authors.

Adult↗
PubMed1997

A survey of general practitioner's confidence in their management of elderly patients.

OBJECTIVE: To assess the confidence of GPs in assessing physical, psychological and social functioning in the elderly and managing complex multi-systems in cooperation with other services and resources in the community. METHOD: One hundred and ninety general practitioners in the Fairfield and Liverpool municipalities were mailed a self-administered anonymous questionnaire which assessed their confidence and barriers to caring for the elderly. RESULTS: One hundred and six general practitioners responded (response rate 55%) with complete questionnaires. Most felt confident in identifying the physical and psychological problems but few felt confident in identifying social problems. Common barriers were patient factors such as reluctance to acknowledge problems, and lack of time. They were equally confident in diagnosing and managing most specific conditions but less so for dementia, depression and functional limitation. While general practitioners rated liaison with geriatricians and primary care services highly, aged care assessment teams were perceived to be poor communicators. CONCLUSIONS: Although most general practitioners felt confident about their general management of their elderly patients, many felt less confident in identifying social problems. More education needs to be provided in 'shared care' of dementia, functional limitations, depression and incontinence.

Aged↗
PubMed1997

A ten year review of the iodine deficiency disorders program of the People's Republic of China.

This paper reviews the Iodine Deficiency Disorders (IDD) Elimination Program of the People's Republic of China (PRC). Over 700 million people live in iodine deficient regions of China and the social and economic consequences of IDD are profound. National and international organisations have supported China's advocacy, social mobilisation and health education programs. Many countries affected by IDD have benefited from discoveries emerging from China's aggressive and effective multisectoral approach to this massive public health problem. The challenge of the next decade is to sustain the momentum through the use of cost-effective monitoring and quality improvement strategies, particularly, in those regions in which a large proportion of babies continue to be at risk of brain damage due to iodine deficiency. This paper sets China's IDD Program in an international context by reference to the literature and through consultation with public health experts.

China↗