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Biomedical subjects

M L Jacobs

Publications and source records attributed to M L Jacobs.

83 records · Page 5Linked to original sources
PubMedDate not supplied

Retention of homeless clients in substance abuse treatment. Findings from the National Institute on Alcohol Abuse and Alcoholism Cooperative Agreement Program.

Retaining clients in treatment who are homeless presents a particular challenge for substance abuse treatment providers. A National Institute on Alcohol Abuse and Alcoholism Cooperative Agreement Program offered the first opportunity to systematically study program retention in a multisite study of interventions for homeless persons with alcohol and other drug problems. This article presents results from analyses conducted across 15 interventions implemented at 8 Cooperative Agreement sites. Both qualitative and quantitative data were collected and analyzed. Key findings were that (a) retention problems with homeless clients are as or more pervasive than in the general addicted population; (b) the provision of housing increases retention, but the increases tend to be nullified when the housing is bundled with high-intensity services; (c) homeless clients leave treatment programs for a multitude of reasons; and (d) midcourse corrections to increase retention are frequently successful. The discussion focuses on service components related to retention, the importance of attending to phase transitions, and the importance of being programmatically responsive when serving this population.

Alcoholism↗
PubMedDate not supplied

Doppler echocardiographic analysis of flow in the ductus arteriosus of infants with hypoplastic left heart syndrome: relationship of flow patterns to systemic oxygenation and size of interatrial communication.

Excessive pulmonary overcirculation related to imbalance in the pulmonary/systemic vascular resistance ratio contributes to hemodynamic instability in infants with the hypoplastic left heart syndrome. Because the ductus arteriosus bridges the two vascular circuits in this lesion, we studied the Doppler echocardiographic flow patterns in the ductus arteriosus of 50 infants with hypoplastic left heart syndrome to investigate their relationship to the degree of pulmonary blood flow as measured by simultaneously obtained levels of partial pressure of oxygen in arterial blood. The degree of restriction to pulmonary venous egress as determined by size of the interatrial communication was also correlated with ductal flow patterns and partial pressure of oxygen in arterial blood. Biphasic flow was noted in all infants. Mean peak velocity of antegrade flow (pulmonary artery to aorta) was greater than that of retrograde flow (aorta to pulmonary artery) (131 +/- 45 cm/sec versus 54 +/- 15 cm/sec; p < 0.001), mean time of retrograde flow was greater than that of antegrade flow (246 +/- 60 msec versus 174 +/- 28 msec; p < 0.001), and mean velocity-time integral of antegrade flow was greater than that of retrograde flow (13.3 +/- 4.8 cm versus 6.3 +/- 3.4 cm; p < 0.001). The ratio of velocity-time integral of retrograde flow/antegrade flow (a volumetric estimate of diastolic reversal into the pulmonary vascular bed indexed to systemic output) correlated extremely well with partial pressure of oxygen in arterial blood (r = 0.91; p < 0.0001). Categoric size of the interatrial communication (none, n = 2; small [<2 mm], n = 9; moderate [3 to 4 mm], n = 23; and large [>4 mm], n = 16) correlated with partial pressure of oxygen in arterial blood (r = 0.82; p < 0.001); the smaller the interatrial communication the lower the partial pressure of oxygen in arterial blood and velocity-time integral ratio of retrograde/antegrade flow. Doppler flow patterns in the ductus arteriosus of infants with hypoplastic left heart syndrome are reflective of the resistance ratio between the pulmonary and systemic vascular circuits and may be helpful in monitoring the hemodynamics of these infants.

Analysis of Variance↗
PubMedDate not supplied

Morphology of the ventricular septal defect in two types of interrupted aortic arch.

Whether coarctation or interruption (IAA) of the aorta, ostensibly similar in morphology (and management), result from the same or different developmental errors can be inferred by examining the pattern of associated anomalies. Among the most common associated lesions, especially in IAA, is ventricular septal defect (VSD). Although muscular and perimembranous VSDs are the most common in aortic coarctation, the prevalence of various VSD morphologies in IAA has not been examined in as much detail. As part of the recent prospective multiinstitutional study of IAA conducted by the Congenital Heart Surgeons Society, 53 echocardiographic studies were reviewed; 42 of 45 patients with type B IAA had VSDs involving maldevelopment of the outflow region. In type A IAA, a significantly lower percentage (4/8) had this kind of VSD. Therefore the mechanism of development of type B IAA is likely to be different from that of type A IAA.

Aorta, Thoracic↗
PubMedDate not supplied

The single ventricle heart in the fetus: accuracy of prenatal diagnosis and outcome.

OBJECTIVES: The purpose of this study was to determine the diagnostic accuracy of fetal echocardiography in evaluating anatomic details of the single ventricle heart and the outcome of fetuses diagnosed with this anomaly. STUDY DESIGN: This is a retrospective study of 57 fetuses in which the results of fetal echocardiography were compared with the diagnoses at postnatal echocardiography, and postnatal surgical outcome was reviewed. RESULTS: Diagnostic accuracy was present in predicting morphology of the predominant ventricle, visceral situs, presence of pulmonary or aortic outflow tract obstruction, and presence of obstructed pulmonary venous outflow (sensitivity 100%). However, the ability to predict for a ductal dependent pulmonary circulation was poor (sensitivity 63%). Errors were made in the fetal assessment of ventricular size and viability such that in three cases, postnatal plans were altered toward a two-ventricular intervention. Of the 57 fetuses, intervention was elected in 37 (75%). Termination or nonintervention was elected in 14, and and 6 died before intervention. Of those operated on, 71% are presently alive after various stages of intervention. CONCLUSIONS: Accurate diagnosis of the fetal single ventricle heart is possible, and outcome is improving. Caution must be used in judging ventricular size and in predicting ductal dependent pulmonary circulation.

Echocardiography↗
PubMedDate not supplied

Early effects of streptozotocin-induced diabetes on insulin-like growth factor-I in the kidneys of growth hormone-transgenic and growth hormone-deficient dwarf mice.

BACKGROUND: The renal growth and hyperfiltration observed in humans and animals with early diabetes might be dependent on growth hormone (GH) and insulin-like growth factor (IGF)-I. The aim of this study was to investigate the early changes in kidney IGF-I in experimental diabetes in mice transgenic for bovine GH and in genetically GH-deficient Ames dwarf mice. METHODS: At 2, 4 and 8 days after a single intraperitoneal injection with streptozotocin, animals were weighted, bled and killed; plasma was analyzed for glucose and IGF-I. IGF-I levels were determined in tissue from snap-frozen kidney and liver. RESULTS: Body weight decreased significantly after the induction of diabetes. Kidney weight increased significantly in GH-transgenic, but not in normal or dwarf mice. Plasma IGF-I was significantly decreased at day 2 in GH-transgenic and normal mice, while liver IGF-I was increased at day 4 in all mice. Kidney IGF-I increased significantly in normal and GH-transgenic mice and was increased more than 3-fold at day 4 in GH-transgenic mice. In dwarf mice, no kidney IGF-I was detectable. CONCLUSION: The diabetes-induced increase in renal IGF-I is dependent on the presence of GH. GH deficiency may protect diabetic animals from early changes in the kidney.

Aging↗