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Biomedical subjects

M Kleinman

Publications and source records attributed to M Kleinman.

At least 19 recordsLinked to original sources
PubMed1999

Inhaled nitric oxide decreases hyperoxia-induced surfactant abnormality in preterm rabbits.

Inhaled nitric oxide (iNO) is a specific pulmonary vasodilator. By serving as a pro-oxidant or antioxidant, iNO may influence other pulmonary functions as well. This study was designed to test the hypothesis that iNO affects the alveolar lining after premature birth. Preterm rabbits (gestation 29 d, term 31 d) were nose-only exposed NO (14 ppm) and 98% O2, for 20 h. The others were exposed to either 98% O2 or air. In another experiment, premature rabbits were exposed to either NO in air or to air. After the exposure, bronchoalveolar lavage (BAL) was performed and the surfactant aggregates were isolated. The surfactant components and surface activity were analyzed. In total, 144 animals were studied. There were no significant differences in the number, distribution, or respiratory burst activity of cells recovered by BAL. Neither brief hyperoxia nor iNO increased plasma-derived proteins in BAL. Exposure to O2 decreased large surfactant aggregates, surface activity, and the content of surfactant protein B in BAL, whereas iNO prevented completely or partially these effects of acute hyperoxia on surfactant. Hyperoxia increased the content of malondialdehyde and decreased glutathione in epithelial lining fluid. iNO decreased malondialdehyde (p < 0.05) and tended to increase glutathione (p = 0.06) in animals breathing O2. Nitrotyrosine was not detectable in BAL, and NO2 was low in the breathing area. In room air, iNO had no significant effect on surfactant. According to the present results, a brief period of hyperoxia causes an oxidant stress and decreases the surface activity of alveolar surfactant in premature rabbits. In contrast, a low dosage of iNO decreased or prevented the O2-induced detrimental effects on alveolar surfactant and alleviated the oxidant stress.

Administration, Inhalation↗
PubMed1996

Psychiatric diagnosis in child and adolescent suicide.

BACKGROUND: The age, sex, and ethnic distribution of adolescents who commit suicide is significantly different from that of the general population. The present study was designed to examine psychiatric risk factors and the relationship between them and demographic variables. METHODS: A case-control, psychologic autopsy study of 120 of 170 consecutive subjects (age, <20 years) who committed suicide and 147 community age-, sex-, and ethnic-matched control subjects who had lived in the Greater New York (NY) area. RESULTS: By using parent informants only, 59% of subjects who committed suicide and 23% of control subjects who met DSM-III criteria for a psychiatric diagnosis, 49% and 26%, respectively, had had symptoms for more than 3 years, and 46% and 29%, respectively, had had previous contact with a mental health professional. Best-estimate rates, based on multiple informants for these parameters, for suicides only, were 91%, 52%, and 46%, respectively. Previous attempts and mood disorder were major risks factors for both sexes; substance and/or alcohol abuse was a risk factor for males only. Mood disorder was more common in females, substance and/or alcohol abuse occurred exclusively in males (62% of 18- to 19-year-old suicides). The prevalence of a psychiatric diagnosis and, in particular, substance and/or alcohol abuse increased with age. CONCLUSION: A limited range of diagnoses--most commonly a mood disorder alone or in combination with conduct disorder and/or substance abuse--characterizes most suicides among teenagers.

Adolescent↗
PubMed1995

Item bias in cognitive screening measures: comparisons of elderly white, Afro-American, Hispanic and high and low education subgroups.

A study of item bias in standard cognitive screening measures was conducted in a sample of Afro-American, Hispanic and non-Hispanic white elderly respondents who were part of a dementia case registry study. The methods of item-response theory were applied to identify biased items. Both cross-cultural and high and low education groups were examined to determine which items were biased. Out of 50 cognitive items examined from six widely used cognitive screening measures, 16 were identified as biased for either high and low education groups or ethnic/racial group membership.

Black or African American↗
PubMed1994

Intraosseous infusion: success of a standardized regional training program for prehospital advanced life support providers.

STUDY OBJECTIVE: To evaluate a standardized training program in intraosseous (IO) infusion for prehospital providers. DESIGN: Prospective multicenter 24-month study. SETTING: IO infusions were performed by prehospital providers from eight advanced life support units serving 14 hospitals within nine counties. PARTICIPANTS: Field advanced life support providers (paramedics and registered nurses). INTERVENTIONS: All providers participated in a one-hour standardized training session and supervised hands-on simulation. Providers completed a data sheet on all IO infusions performed. Data sheets were collected and summarized. RESULTS: One hundred thirty-four prehospital providers completed the training session and were approved to perform the procedure. Fifteen patients requiring IO infusion were encountered during the study period. Thirteen (87%) had IO infusion completed successfully. Clinical indications included 11 patients in cardiac arrest, two trauma resuscitations, one seizure, and one toxic ingestion. Patient ages ranged from 1 to 24 months. Seven patients were initially resuscitated. Four survived to hospital discharge. Procedural complications included one incidence of local fluid extravasation and one IO line that became dislodged en route. There were no complications at time of discharge in the four survivors. All procedures were performed in less than two minutes. CONCLUSION: A one-hour standardized training session was successfully used to train prehospital providers in the procedure of IO infusion. IO infusion then was implemented into their clinical practice with a satisfactory success rate and few complications.

Child, Preschool↗
PubMed1992

The effectiveness of cerebral imaging in the diagnosis of chronic headache.

OBJECTIVE: The increasing availability of high-resolution cerebral imaging scanners has fueled enthusiasm for their use to "rule out" brain tumor and other serious neurologic conditions in patients with headache. The effectiveness of this practice, however, has not been tested since the advent of newer scanning equipment. Our objective was to measure the usefulness of cerebral imaging in patients with chronic isolated headache. DESIGN: A retrospective study with a 15- to 27-month follow-up period. SETTING: A group-model health maintenance organization. PATIENTS: Adult patients, 100,800, in a health maintenance organization and an enriched sample of 63 patients with neurosurgical conditions from other health maintenance organization hospitals. RESULTS: During 1990, 1083 cerebral computed tomographic scans were performed on 863 adults (0.9% of health maintenance organization adults). Eighty-nine patients were scanned for chronic isolated headache; none of the scans provided important new information (95% confidence interval, 0%, 3%). Long-term patient follow-up confirmed that this low yield could not be attributed to diagnostic work-up bias. Further attempts to support a policy of imaging patients with isolated headache were also unsuccessful. Review of an enriched sample of patients with malignant brain tumor and patients requiring craniotomy for other reasons (n = 40) demonstrated that no patient had headache alone at the time of diagnosis (95% confidence interval, 0%, 8%) and that only 5% (95% confidence interval, 0%, 12%) of these patients sought medical attention for headache alone. Sampling a second enriched sample of patients who were referred from other hospitals (n = 63) because of conditions requiring neurosurgical procedures demonstrated that only 6% of patients presented with chronic isolated headache alone (95% confidence interval, 0%, 12%). Uncertainty regarding the appropriateness of imaging patients with headache was illustrated by the extreme interphysician variability of this practice. CONCLUSION: Our study demonstrates the large potential cost and low (although not zero) yield associated with nonselectively imaging patients with chronic isolated headache.

Adult↗
PubMed1990

Time-space clustering of teenage suicide.

The occurrence of time-space clusters was examined in national mortality data on suicide among adolescents aged 15-19 years obtained from the National Center for Health Statistics Mortality Detail Files for 1978-1984. The analyses indicated that overall significant time-space clustering occurred among 15-19 year olds. The authors thus believe that they have documented for the first time that outbreaks of suicide occur more frequently than expected by chance alone. The occurrence of suicide clusters among teenagers appeared to vary considerably by state and year of investigation. There is some indication that there has been an increase in teenage clusters in more recent years.

Adolescent↗
PubMed1989

Use of the scan statistic to detect time-space clustering.

A test for time-space clustering is proposed based on the scan statistic, the maximum number of events in a 365-day period in each of several geographic units. The data under consideration should consist of the exact date and geographic unit for each event, and data should be available for several years for which the risk of disease can be assumed constant. The statistic is the ratio of the excess number of events summed over all the geographic regions, to the square root of the sum of the variances. This statistic is similar in construction to the Ederer-Myers-Mantel statistic (Biometrics 1964;20:626-38), but does not require that attention be limited to calendar years (January 1-December 31). Unlike other tests for time-space clustering, the scan statistic allows one to calculate measures of attributable risk and effect size. Data concerning adolescent suicide are used to illustrate the procedure. The tables and asymptotic formulas given for the mean and variance of the proposed statistic should be useful in the evaluation of both clustering in time and in time-space.

Adolescent↗
PubMed1985

Prophylactic antimicrobials in elective colorectal and biliary surgery.

In 97 patients undergoing elective biliary (44) or colorectal (53) surgery, cases were randomly allocated to receive peri-operative prophylaxis with either cefoxitin (Mefoxin; MSD) or metronidazole, penicillin and tobramycin (MPT). Sepsis occurred in 3 of the biliary cases (6,8%) and in 16 of the colorectal cases (30,2%). In the colorectal group sepsis occurred equally in patients receiving cefoxitin (22,2%) or MPT (38,5%) (P = 0,20). Patients who developed sepsis did not have a prolonged hospital stay; strict criteria were used to define sepsis in this study and this explains the apparently high sepsis rate. A positive wound culture at the end of the operation was more common after colorectal surgery (30,2%) than after biliary surgery (4,6%) and was associated with a higher subsequent infection rate (P = 0,02).

Aged↗
PubMed1981

Survivors of the holocaust and their children: current status and adjustment.

A group of 52 concentration camp and other survivors of World War II were compared with a control group of 29 persons of similar European and religious background. Forty-seven children of these survivors and 16 children from the comparison group were also evaluated. The psychological adjustment of both group of adults and their children was within the normal range. Cultural rather than specific survivor influences were noted in the present attitudes and behaviors of the parents. There were no significant differences between the survivor and control group children on any of the psychological variables or in thier attitudes and behaviors toward their parents. Based on these findings, we questioned notions of survivor guilt, the manifestation of emotional blunting in the survivors, and the extremely maladaptive psychological influence of their parents' experiences on the children of survivors.

Adjustment Disorders↗
PubMed1977

Ability factors in motor learning.

Research dealing with the role of basic ability factors in motor learning has been characterized by an ever increasing realization of the high degree of task specificity associated with the acquisition of motor skills. Although various theoretical arguments have been offered to account for the changing factor structure of abilities which apparently accompanies increase in proficiency in motor performance, such theories have, by and large, ignored the role of information-processing models, as well as factors pertaining to human neurological organization. Theoretical positions and empirical research concerning the role of ability factors in motor learning are discussed and analyzed in the light of the limitations imposed by factors of task taxonomy.

Aptitude↗
PubMed1969

Radionuclide concentrations in surface air: direct relationship to global fallout.

By relating the average monthly hemispheric concentrations of radionuclides in the suirface air to the monthly hemispheric fallout of these nuclides, we have derived proportionility constants. For every disintegration per minutte of a radioactive nutclide per 1000 cubic meters of the suirface air in the Northern Hemisphere, 3.3 kilocuirics of that nutclide will be deposited on the surface; in the Soluthern Hemisphere, 5.0 kilocutries will deposit for every disintegration per minutte per 1000 cuibic meters. Oni the basis of thlese factors, the global deposition of radionuclides can be estimated from a relatively small numbnber of measurements of the radioactivity in the surface air.

Air Pollution, Radioactive↗