Biomedical subjects
M J Ball
Publications and source records attributed to M J Ball.
Informatics education and the professions.
This Perspectives is the outgrowth of work begun at Maryland under the Informatics Task Force and its national and international advisory groups. In a theoretical discussion of what information science can contribute to the health professions, the authors address questions of definition and describe application and knowledge models for the emerging profession of informatics. A review of existing programs includes curriculum models and provides details on informatics programs emphasizing information and computer science; programs emphasizing the health sciences; and specialized informatics programs (undergraduate, master, and doctoral level). Focus is placed on models for informatics program development. The authors hope to build upon the database reported on in this article, and thereby foster the informatics education for the professions.
Comparison of medium and long chain triglyceride metabolism in intensive care patients on parenteral nutrition.
The metabolic effects of an intravenous lipid emulsion containing medium chain triglycerides (MCTs) were studied in eleven critically ill, ventilated patients receiving parenteral nutrition. The effects were compared in a cross-over study with those of a conventional emulsion containing only long chain triglycerides (LCTs). The lipid was well tolerated, but there were differences in the metabolic effects with a significantly greater increase in the plasma concentrations of glycerol and ketones during MCT/LCT infusion compared to LCT. The plasma concentration of non esterified fatty acids was also higher. This fell rapidly post infusion. Since non esterified fatty acids and ketones are readily available energy sources for tissues lipid emulsions containing MCT may prove valuable for catabolic, critically ill patients.
Nicotinic binding sites in cerebral cortex and hippocampus in Alzheimer's dementia.
Postmortem cerebral neocortical and hippocampal samples were taken from patients who died with dementia of the Alzheimer type (DAT) and individuals without diagnoses of neurological or psychiatric disease (control). Nicotinic binding was assayed with 20 nM [3H]acetylcholine [( 3H]ACh) in the presence of atropine, or with 4 nM (-)-[3H]nicotine ((-)-[3H]Nic). Binding of both ligands was lower in the following regions from DAT vs. control brains (P less than or equal to 0.05): superior, middle and inferior temporal gyri, orbital frontal gyrus, middle frontal gyrus, pre- and postcentral gyri, inferior parietal lobule, and hippocampal endplate. Values of the correlation coefficient (r's) for binding of the nicotinic cholinergic ligands in these regions ranged from 0.70 to 0.93 (P's less than 0.05), suggesting that [3H]ACh and (-)-[3H]Nic labeled the same sites in human brain. There was no difference in nicotinic binding in the presubiculum, comparing DAT and control samples (P greater than 0.05). Here too, correlations between binding of the two ligands were statistically significant in control and DAT groups (r's = 0.92, P's less than 0.05). Nicotinic binding measured with [3H]ACh, but not (-)-[3H]Nic, was significantly lower in the H2 (field of Rose) and H1-subiculum areas of DAT samples compared to control. Correlations between binding of the two ligands in these regions ranged from 0.21 to 0.34 for the two groups (P's greater than 0.05). The findings support a loss of neocortical and hippocampal nicotinic cholinergic binding sites in DAT.(ABSTRACT TRUNCATED AT 250 WORDS)
Variation in the apo AI/CIII/AIV gene complex: its association with hyperlipidemia.
This study shows that 33.3% of English patients with primary hyperlipidemia (52/156) had the S2 allele of the apo AI/CIII/AIV complex compared to 6.1% of normolipidemic individuals (3/49). The increased frequency of the allele was statistically significant in each of the hyperlipidemic groups (type IIA, excluding patients with FH, type IIB and IV) examined and was not specifically related to hypertriglyceridemia. This finding may account for the result of several studies which showed groups of patients with CHD had a significantly higher prevalence of the S2 allele than control groups. Our data do not support the notion that the increased frequency of this allele in CHD patients is independent of variations in plasma lipid levels, since we find the frequency of the S2 allele in an apparently healthy hyperlipidemic group of patients is very similar to a hyperlipidemic group with symptomatic premature atherosclerotic disease. This study also shows the BMI of the type IIB and IV hyperlipidemic patients is significantly higher than the type IIA (no xanthomas) group. This may modulate the expression of the defect associated with the S2 allele. When the type IIB and IV hyperlipidemic groups were divided into 2 groups according to their apo AI/CIII/AIV genotype (i.e., S1S1, S1S2 (including S2S2] there was no significant difference in the mean plasma level of total cholesterol, HDL-cholesterol and triglycerides between the 2 groups. In contrast the S1S2 type IIA individuals had higher plasma cholesterol levels.
Metabolic effects of intravenous medium- and long-chain triacylglycerols in critically ill patients.
1. The metabolic effects of an intravenous lipid emulsion containing medium-chain triacylglycerols (MCT) and long-chain triacylglycerols (LCT) were studied in 16 critically ill, ventilated patients. The effects were compared in a cross-over study with those of a conventional emulsion containing only LCT. 2. The lipid was well tolerated but the metabolic effects of the MCT/LCT infusion differed from those of the LCT infusion. 3. The major differences were a 60% higher insulin concentration and a significantly greater increase in the plasma concentrations of non-esterified fatty acids during MCT/LCT infusion than during LCT infusion. The mean rise in plasma ketone concentration was also higher during MTC/LCT infusion, although this did not reach statistical significance.
HLA association of anti-IgA antibody production.
We have HLA typed 46 unrelated IgA deficient blood donors in our region. A weak association to DR3 (RR = 2.07) was observed. However, owing to the heterogeneous nature of this group, we found DR7 may be associated with those who developed class-specific anti-IgA antibodies (RR = 2.94), whereas DR1 may be associated with those who did not (RR = 2.42).
Informatics in professional education.
The University of Maryland at Baltimore (UMAB) is a professional school campus, including schools of Dentistry, Law, Medicine, Nursing, Pharmacy, Graduate Studies, and Social Work and Community Planning. In late 1987, UMAB convened a Task Force on Informatics, intended to support the campus as it worked to become a Centre of Excellence for Informatics. The Task Force reviewed the current computing environment at UMAB and the individual schools. In assessing the state of the art in informatics, its work was supplemented by the formation of external advisory committees of national and international informaticians. Deliberations proceeded according to a methodology designed to develop factual databases and to generate consensus. The Task Force report, which is excerpted in the following paper, established a tiered taxonomy of competencies; defined the three levels; and set forth program models for the two higher levels. Special note was made of the programs in nursing and dental informatics newly established at UMAB. The report concluded with three recommendations, each with detailed action points identified.
Integrated Academic Information Management Systems (IAIMS). Part II. Planning and implementing integrated information services. Integration and outreach: Integrated Academic Information Management Systems (IAIMS) at Maryland.
The University of Maryland Campus for the Professions is now realizing the first benefits of integrated academic information management systems (IAIMS). With the support of the National Library of Medicine, the information Resources Management Division has joined with the Health Sciences Library to plan and to implement change. Within the information utility concept, networked data communications and end-user computing function as the means to integration. Plans call for new 370-based software to extend system capabilities. Mechanisms for outreach ensure that the potential of integration is realized. These mechanisms include technology assisted learning centers, informatics program development, special programs (geriatrics, hypertension pilot), and new applications (conferencing system, voice mail, videodisc development, interinstitutional resource sharing).
Informatics and education in the health professions.
Informatics, the applied use of information science, is undergoing definition and development in the health professions with the encouragement of the National Library of Medicine and other professional organizations. Medical informatics and disciplinary subsets such as nursing and dental informatics look to optimize a growing range of applications ranging from video-disks to expert systems. Recommendations call for the integration of informatics into the education of health care professionals. Academic health sciences centers are developing informatics programs; the University of Maryland Campus for the Professions has convened a task force and a national advisory board on informatics.
How to select a computerized medical office practice system.
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Isolation and chemical characterization of Alzheimer's disease paired helical filament cytoskeletons: differentiation from amyloid plaque core protein.
The paired helical filaments (PHFs) of Alzheimer's disease were purified by a strategy in which the neurons and amyloid plaque cores of protein (APCP) were initially isolated. This was achieved by several steps of isocratic sucrose centrifugations of increasing molarity and a discontinuous isotonic Percoll density gradient. After collagenase elimination of contaminating blood vessels, lysis of neurons was produced by SDS treatment. The released PHF cytoskeletons were separated from contaminating APCP and lipofuscin by sucrose density gradient. A final step consisted in the chemical purification of highly enriched PHFs and APCP components via a formic acid to guanidine hydrochloride transition. PHFs and APCPs were fractionated by size exclusion HPLC and further characterized and quantitated by automatic amino acid analysis. We also present some of the morphological and immunochemical characteristics of PHF polypeptides and APCP. Our studies indicate that apart from differences in localization and morphology, PHF and APCP significantly differ in (a) chemical structure (peptide and amino acid composition); (b) epitope specificity (antiubiquitin, antitau, antineurofilament); (c) physicochemical properties (structural conformation in guanidine hydrochloride); and (d) thioflavine T fluorescence emission. These parameters strongly suggest important differences in the composition and, probably, in the etiopathology of PHF and APCP of Alzheimer's disease.
Neuropathological definition of Alzheimer disease: multivariate analyses in the morphometric distinction between Alzheimer dementia and normal aging.
Although establishing that a patient is suffering from dementia of the Alzheimer type initially reflects a clinician's opinion, neuropathological study is for the present the most definitive examination to confirm the clinical diagnosis of Alzheimer disease. We review several comprehensive publications attempting on a quantitative basis to differentiate the changes occurring with normal aging of the human brain from those indicative of Alzheimer disease. New morphometric data on 5 histopathological lesions in the mesial temporal cortex of 42 subjects indicate that, when multivariate analyses are performed on such microscopic information, a diagnostic prediction about the brain of any unknown individual should indeed be possible with a statistically calculated degree of certainty.
Dementia in Down's syndrome: cerebral glucose utilization, neuropsychological assessment, and neuropathology.
We measured the cerebral metabolic rate for glucose (CMRglc) with positron emission tomography and [18F]2-fluoro-2-deoxy-D-glucose in a 47-year-old man with trisomy 21 Down's syndrome (DS) and autopsy-confirmed Alzheimer's disease. Dementia was evident from a confirmed history of cognitive decline, memory loss, and personality change. CMRglc in the subject was compared with the mean obtained in 13 healthy younger DS subjects, aged 19 to 33 years. Test scores of general intelligence, visuospatial ability, language, and memory function showed poorer performance in the older subject compared with the younger group. Mean hemispheric CMRglc in the older DS subject was 28% less than in the young DS group, and marked hypometabolism was evident in parietal and temporal lobe association cortices. At autopsy, extensive neuropathology was noted, especially in the parietal and temporal cortical regions, more so than reported in DS subjects without documented dementia. This study is the first complete assessment of cerebral metabolism, neuropsychological competence, and neuropathology in a DS subject with a documented course of dementia, and demonstrates the superimposition of Alzheimer type dementia on previous mental retardation.
Experiences with an MCT-containing parenteral nutrition regimen in patients receiving routine TPN.
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The total parenteral nutrition service: an update.
A total parenteral nutrition (TPN) service was established in Oxford in 1978 and the results of the first 3 years were published in 1983. Since then the service has provided intravenous nutritional support to an increasing number of patients, representing a considerable and increasing financial burden on the constrained hospital budget. To assess whether this expansion is justified, and whether regular review has improved the care given to patients, a further audit has been performed for the period 1983 to 1986. Despite an increase of approximately 60% in the numbers of patients parenterally fed, line associated morbidity was less and there were no serious metabolic problems or deaths. Patient selection has improved, as judged by fewer patients fed for periods less than a week. Regular audit appears to improve the selection and treatment of patients but there remains a need to identify subgroups of patients for whom this costly form of nutrition is essential.
Tying it all together: The Integrated Academic Information Management System being implemented at Maryland.
With the National Library of Medicine serving as the catalyst, the University of Maryland at Baltimore, Campus for the Professions, entered into a major initiative to integrate information management systems in support of the campus missions of education, research, and clinical care. Strategic planning initiated the integration process and continues in an iterative mode. In support of integration, changes were made in the campus organizational structure and in its technological infrastructure. Implementation involves transforming the Information Resources Management Division into an information utility on a phased and incremental basis. Collaboration with the Health Sciences Library is key to this transformation, as are numerous outreach activities.
Left-right symmetry of neuronal cell counts in the nucleus basalis of Meynert of control and of Alzheimer-diseased brains.
The nerve cell counts indicated that the neuronal population of the nucleus basalis of Meynert (nbM) was bilaterally symmetrical in both control and Alzheimer-diseased brains. In addition, the discussion deals with the possibility that a loss of neurons from rostral vs caudal parts of the nbM may occur during different stages of the disease.