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Biomedical subjects

M K Miller

Publications and source records attributed to M K Miller.

At least 55 records · Page 3Linked to original sources
PubMed1990

The effect of religious concentration and affiliation on county cancer mortality rates.

Previous research has documented lower cancer mortality rates among religious groups characterized by doctrinal orthodoxy and behavioral conformity. In addition, there is evidence that the general population in an area with a high concentration of religious participants may experience health benefits resulting from diminished exposure to or increased social disapproval of behaviors related to cancer mortality. This research examines the effect of religious concentration and denominational affiliation on county cancer mortality rates. Our findings suggest that religion has a significant impact on mortality rates for all malignancies combined, for digestive cancer, and for respiratory cancer when we control for demographic, environmental, and regional factors known to affect cancer mortality. These results provide new insight into the relationship between religion and health at the macro or community level and suggest that the influence of religion on social structure warrants further attention.

Female↗
PubMed1989

Determinants of the uncompensated care burden of rural and urban hospitals in Florida.

It has been projected that over the next decade as many as 700 hospitals will close due to financial pressures created at least in part by the problem of uncompensated care. Many analysts contend that smaller, rural hospitals will be disproportionately represented among those which close. This investigation uses data collected from over 14,000 inpatient records from 130 representative hospitals in Florida to examine the degree to which rural hospitals experience an uncompensated care problem which differs in source, or magnitude, from that experienced by urban institutions. The analyses show that 150 days following the provision of service, the mean per capita outstanding amount was $18 higher for patients seen in rural hospitals than those seen in urban hospitals. Further, the odds of a rural hospital patient having some outstanding balance 150 days after service had been rendered ranged from 1.2 to 1.3 times those for patients seen in urban hospitals. The location difference is not eliminated by controlling for sociodemographic differences of the patients or the circumstances surrounding the type and/or source of admission. The single most important predictor of having outstanding hospital charges is possession of health insurance. Patients with no coverage are 38.6 times more likely to have some nonzero outstanding balance than patients with some form of insurance coverage. After controlling for sociodemographic, economic, and circumstances surrounding admission, the odds increase from 38.6 to 73.6. The critical role played by insurance is further evidenced by noting that the odds of someone with third party insurance coverage having an unresolved amount greater than or equal to $250 is only .024 and only slightly higher (.048) for government coverage.

Accounting↗
PubMed1988

Comparison of TEM and APFIM in microstructural characterization and interpretation: an overview.

A comparison of transmission electron microscopy (TEM) and atom probe field-ion microscopy (APFIM) is presented with respect to the interpretation of complex microstructures, phase identification, determination of crystallographic order, and analysis of interfaces. The capabilities, spatial resolutions, and limitations of each technique are discussed with examples taken from combined analytical electron microscopy (AEM) and APFIM studies. Both techniques are extremely powerful for routine characterization of a wide range of materials, although care must be exercised in experimentation and interpretation. The combined use of TEM and APFIM is synergistic and extends their individual capabilities from the macro scale to the atomic level.

Electron Probe Microanalysis↗
PubMed1988

Group B streptococcal (GBSS) newborn septic shock model: the role of prostaglandins.

Group B beta hemolytic streptococcal sepsis has many of the characteristics of gram negative sepsis (Hellerqvist, et al., 1981). This is further shown in the model developed for this study. The newborn piglet septic model developed for this study appears to be an adequate model for group B, beta-streptococcal sepsis characterized by the development of significant hypotension by six hours. As with human sepsis, this model develops hypoglycemia, hemoconcentration as noted by the increased hematocrit, thrombocytopenia and a significant drop in WBC with an increase in immature forms (Wilson, 1986). The only finding not correlated to the septic newborn is the development of DIC as characterized by an increased PT/PTT and increased FSP. As with other animal models for both gram positive and negative sepsis, the cyclooxygenase inhibitor, indomethacin significantly increased survival out to 72 hours. Previous studies with thromboxane synthetase inhibitors have not shown increased survival, but shunting into the prostacyclin pathway has occurred and the effect of this on survival could not be ruled out (Short, et al., 1983). The use of a thromboxane receptor site antagonist should not cause this shunt, and thus may help to evaluate the effect of thromboxane blockade. In this model no effect of the receptor site antagonist was noted, but due to the short half-life of this compound, a different dosing schedule may be needed before its efficacy can be determined. In summary, the cyclooxygenase inhibitors do appear to have a protective effect in gram positive sepsis, but the mechanisms of action are still to be determined.

Animals↗
PubMed1987

Intracranial flow patterns in infants undergoing extracorporeal membrane oxygenation: preliminary observations with Doppler US.

Transcutaneous Doppler ultrasound was used to monitor changes in intracranial hemodynamics in 13 infants undergoing extracorporeal membrane oxygenation (ECMO). Recordings for the pericallosal portion of an anterior cerebral artery were obtained before ECMO and daily during ECMO bypass, with use of a range-gated, pulsed Doppler imaging system. Obvious changes occurred with the onset of ECMO: the systolic phase broadened, and diastolic flow velocities markedly increased. The mean pulsatility value, as measured with the Pourcelot pulsatility index, decreased significantly at the start of ECMO and over time during ECMO bypass. Marked increases in the area under the velocity curve (AUTC) were also observed with the institution of ECMO bypass (mean percentage change in AUTC from baseline, 133%). Factors that appeared to affect AUTC included PCO2, mean blood pressure, and ECMO bypass rate. AUTC tended to decrease during the course of ECMO. Although the clinical significance of these findings remains unclear, the data indicate that ECMO bypass is associated with marked changes in intracranial hemodynamics.

Cerebrovascular Circulation↗
PubMed1987

Intracranial abnormalities in infants treated with extracorporeal membrane oxygenation: imaging with US and CT.

Findings at neuroimaging in 100 consecutive infants treated with extracorporeal membrane oxygenation (ECMO) are presented. Imaging in these infants consisted of pretreatment cranial ultrasonography (US), daily US studies while on ECMO, and follow-up cranial computed tomography (CT) after treatment. There were findings of abnormalities in 43 patients. Thirty had intracranial bleeding, often of unusual extent and distribution. Thirteen additional infants had nonhemorrhagic abnormalities alone. Bleeding considered to be major was seen in 12% of infants. Large parenchymal hemorrhages and infarcts, cerebellar hemorrhages, and diffuse edema were the most significant abnormalities, with a 50% mortality (eight of 16 patients). No lateralization was noted with respect to distribution of bleeding sites or areas of nonhemorrhagic abnormalities. US was a sensitive but imperfect screening tool for intracranial abnormalities. Abnormalities missed with US included peripheral and small parenchymal lesions, subarachnoid hemorrhage, cerebral atrophy, and sagittal sinus thrombosis.

Brain↗
PubMed1987

Neurologic status in infants treated with extracorporeal membrane oxygenation: correlation of imaging findings with developmental outcome.

A retrospective review was done of intracranial images obtained within the newborn period in 46 infants who had been treated with extracorporeal membrane oxygenation (ECMO). A neuroimaging score was determined on the basis of the extent and severity of findings on both ultrasound and computed tomographic scans. Presence of abnormality at neuroimaging and the neuroimaging score were correlated with the findings of neurodevelopmental evaluations (Bayley scales) performed in infants who were at a mean age of 11.8 months (range, 6-16 months). A significant inverse correlation was found between the neuroimaging score and mental and psychomotor development indexes of the Bayley scale (P less than .005). Mean neuroimaging scores in infants with normal development were significantly lower than those in infants with delayed development (P = .002). Although individual outcomes cannot be predicted with neuroimaging, the neuroimaging score can be a useful adjunct in assigning patients who survive with ECMO treatment to risk categories for developmental outcome.

Brain↗
PubMed1986

Criteria for extracorporeal membrane oxygenation in a population of infants with persistent pulmonary hypertension of the newborn.

Extracorporeal membrane oxygenation (ECMO) has been available since 1975 as a therapy of last resort to provide adequate oxygenation for term infants with acute lung disorders that do not respond to maximal medical therapy. Virtually all term infants with serious lung disease have persistent pulmonary hypertension of the newborn (PPHN) characterized by significant right-to-left shunting of blood and severe diffusion defects manifested as increased alveolar-arterial oxygen gradients (AaDO2). Criteria for initiation of ECMO therapy have been developed in several institutions but at the present time there are no universal criteria applicable to all infants with PPHN. We have attempted to establish entry criteria that may be used for different populations of infants with PPHN. Based on a retrospective review of 30 infants with PPHN in our institution, we have defined standards of maximal medical therapy. An alveolar-arterial oxygen difference (AaDO2) of greater than or equal to 610 for 8 hours has been shown to be associated with 79% mortality in this population. This AaDO2/time interval is established as a major criterion for institution of extracorporeal membrane oxygenation.

Carbon Dioxide↗
PubMed1986

The economic costs and benefits of adding medical manpower to rural and urban communities: a human capital perspective.

For health planners to be able to use scarce resources efficiently and effectively to improve health, it is necessary for them to have reliable information on the productivity of the major categories of health producing expenditures. The present study utilizes a human capital perspective to evaluate the economic costs and benefits of medical manpower to communities in the West South Central United States. The results of the study suggest that beyond problems of maldistribution of physicians and nurses, the larger problem from an economic effectiveness perspective may be significant excesses of medical manpower, although some rural communities could justify, economically, adding physicians and/or nurses to reduce lost human capital. The findings indicate a need to further rationalize the allocation of health care resources as well as the need to consider means other than increased spending on curative medicine (e.g., health promotion and health education) as a strategy for efficiently meeting the objective of improving public health.

Cost-Benefit Analysis↗