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Biomedical subjects

M McCall

Publications and source records attributed to M McCall.

At least 19 recordsLinked to original sources
PubMed1999

Childhood malnutrition and postwar reconstruction in rural El Salvador: a community-based survey.

CONTEXT: The 1992 peace settlement that ended the civil war in El Salvador included land redistribution and other provisions designed to improve the socioeconomic status of ex-combatants and vulnerable civilians. OBJECTIVE: To describe associations between postwar social and economic assistance programs, especially land reform, and current child health status as reflected by nutrition in a population of resettled rural refugees. DESIGN: A population-based cross-sectional survey of child nutritional status and principal elements of the reconstruction process. SETTING: A single rural municipality in northern El Salvador. PARTICIPANTS: A representative sample of 761 children younger than 5 years, living in 27 villages. MAIN OUTCOME MEASURE: Prevalence of stunting (low height for age) in children younger than 5 years. RESULTS: Prevalence of stunting was 32.4%. Stunting was significantly more prevalent among children whose families cultivated less land (odds ratio [OR] for stunting per additional hectare of redistributed land cultivated, 0.64; 95% confidence interval [CI], 0.44-0.93). Less than half of newly transferred land was being cultivated by its owners. Most of the children (84.7%) lived in families cultivating 2 hectares or less of redistributed land. Stunting was also more prevalent among children whose households lacked piped water (adjusted OR, 2.72; 95% CI, 1.87-3.96) vs those who had had piped water since before the cease-fire. CONCLUSIONS: Malnutrition, particularly stunting, persisted at high levels and was strongly associated with delay in full cultivation of redistributed land and in provision of water.

Body Height↗
PubMed1998

Clinical trial and local process evaluation of an apheresis system for preparation of white cell-reduced platelet components.

BACKGROUND: A new method for the consistent preparation of white cell (WBC)-reduced plateletpheresis components, the Spectra Leukoreduction System (LRS), was evaluated by clinical trial and local process validation. The centrifuge-based system was projected to decrease the WBC content of plateletpheresis components to a level below 1 x 10(6) per unit. Phase I and II clinical trials were performed. The manufacturer's claims were then tested at the local level with an ongoing quality assurance program. STUDY DESIGN AND METHODS: In Phase I, a cross-over analysis of five subjects compared LRS to standard plateletpheresis procedures in collection efficiency and component quality: a panel of in vitro measures was taken on Day 0 and Day 5. In Phase II, the LRS process was tested on a larger scale (n = 57; control = 58) with component transfusion. Finally, validation, determination of degree of conformance with standards, and ongoing quality control were performed locally on a newly installed instrument. RESULTS: Phase I and II trials revealed no significant differences between LRS and control units in donor or recipient safety and comfort, platelet function and yield, or component volume. WBC per-unit values were significantly different: the LRS median per unit was 3.2 x 10(4) WBCs, versus 81.4 x 10(4) for control units. Assessment of process capability gave an estimate of 99-percent confidence that 99.5 percent of LRS units would be WBC reduced to < 1 x 10(6) WBCs. Local process validation and quality control revealed 90-percent confidence that 99 percent of the units would be WBC reduced and 99.9-percent confidence that 75 percent would exceed platelet yield standards; the process was stable over time. CONCLUSIONS: The LRS is safe for apheresis and the component produced is safe for transfusion with platelet function and yield equivalent to controls and WBC reduction superior to controls. Local process evaluation confirmed that component quality meets the goals of the institution.

Blood Banks↗
PubMed1998

Health-related physical function and quality of well-being prior to and following cardiomyoplasty. A preliminary report.

OBJECTIVE: The purpose of this study was to obtain preliminary data regarding the effects of cardiomyoplasty on health-related physical function and quality of well-being. EXPERIMENTAL DESIGN: Quasi-experimental with repeated measures. Patients were interviewed prior to surgery, with post-surgical follow-up interviews at 6 weeks, 6 months, and 12 months. SETTING: Interviews were usually conducted by telephone with patients who were at home at the time of data collection. PATIENTS OR PARTICIPANTS: Four patients receiving cardiomyoplasty at Allegheny General Hospital in Pittsburgh, Pennsylvania. INTERVENTIONS: Patients received cardiomyoplasty between November 1992 and April 1993. Cardiomyoplasty using the right latissimus dorsi muscle was performed on the first patient. A left muscle-wrap was performed on the subsequent three patients. MEASURES: Self-reported function and well-being were measured using the Sickness Impact Profile (SIP), the Quality of Well-Being Scale (QWB), and the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36). RESULTS: Patient responses on the SF-36 demonstrated general improvement in cardiomyoplasty survivors. Results on the QWB and SIP are mixed. CONCLUSIONS: Due to the small, incomplete sample and lack of any comparison group, extreme caution must be used in drawing any clinical conclusions from this preliminary data. Future randomized clinical trials of cardiomyoplasty need to include quality of life and health-related physical function as dependent variables. Further psychometric study is necessary which compares the usefulness of these various methods for assessing the value of outcomes for patients with end-stage heart disease.

Aged↗
PubMed1998

Multiple genetic loci modify risk for retinoblastoma in transgenic mice.

PURPOSE: Forty percent of cases of retinoblastoma, a childhood malignancy of the retina, are linked to the inheritance of a mutant allele of the retinoblastoma susceptibility gene Rb1. Tumor penetrance varies among carriers in different family pedigrees, indicating that other genetic factors may modify risk for occurrence of retinoblastoma. This study was undertaken to determine whether multiple genetic loci modify the risk for retinoblastoma in mice. METHODS: A line of alphaAcry-HPV16E6/E7 transgenic mice expressing the human papillomavirus type 16 E6 and E7 oncogenes (HPV-16 E6 and E7) ectopically in the retina was characterized. E6 and E7 proteins bind to and inactivate the cellular tumor suppressor proteins p53 and Rb, respectively. RESULTS: Retinoblastomas developed rarely when the alphaAcry-HPV16E6/E7 transgene was maintained on the FVB background, but tumors arose with high frequency on C57BL/6 X FVB and C3H x FVB F1 hybrid backgrounds. The incidence of retinoblastoma in the LHbeta-TAG transgenic mice, which express simian virus 40 large tumor antigen (SV40 T-ag), was also influenced by the FVB and C57BL/6 backgrounds. Resistance of the alphaAcry-HPV16E6/E7 FVB mice to retinoblastoma mapped in part to the retinal degeneration (rd) locus. However, multiple genetic experiments indicate that resistance to retinoblastoma depends on additional loci in FVB mice. CONCLUSIONS: Multiple cellular genes can modify risk for retinoblastoma in mice.

Animals↗
PubMed1997

The effects of physical attractiveness on gaining access to alcohol: when social policy meets social decision making.

Despite numerous legal interventions, minors continue to purchase and consume alcohol. Prior research had suggested that the decision to request identification to prove legal age was susceptible to various judgement and decision heuristics. This research examined whether the physical attractiveness of the potential consumer and the presence or absence of others were significant predictors of alcohol accessibility. Bartenders (n = 130) rated a target individual who was either high or low in attractiveness. Results indicated that attractiveness was a significant predictor of "proofing likelihood". High levels of attractiveness were associated with a decrease in the likelihood of being asked to provide proof of legal age for the purchase of alcohol. Individuals presented alone were seen as significantly older than when grouped with others. Implications of these findings for the restriction of alcohol availability among minors are considered.

Adult↗
PubMed1996

Unexpected anisotropy in substrate cleavage rates by asymmetric hammerhead ribozymes.

RNA substrates which form relatively short helices I and III with hammerhead ribozymes are generally cleaved more rapidly than substrates which create longer binding helices. We speculated that for optimum cleavage rates, one of the helices needed to be relatively weak. To identify this helix, a series of ribozymes and substrates of varying lengths were made such that in the complex, helices I and III consisted of 5 and 10 bp respectively or vice versa. In two independent systems, substrates in the complexes with the shorter helix I and longer helix III were cleaved one to two orders of magnitude more rapidly than those in the complexes with the longer helix I and shorter helix III. Similar results were obtained whether the numbers of base pairs in helices I and III were limited either by the length of the hybridizing arms of the ribozyme or the length of the substrate. The phenomenon was observed for both all-RNA and DNA armed ribozymes. Thus, a relatively short helix I is required for fast cleavage rates in pre-formed hammer-head ribozyme-substrate complexes. When helix III has 10 bp, the optimum length for helix I is approximately 5 bp.

Animals↗
PubMed1996

Pursuing conception: a physician's experience with in-vitro fertilization.

Infertility is a common problem. Approximately one in seven North American couples will experience it, either by being unable to conceive after a year of trying or by experiencing recurrent miscarriages. A family physician outlines her experiences when being treated for infertility by in-vitro fertilization and embryo transfer.

Autobiographies as Topic↗
PubMed1996

Does QI work? The Management to Improve Survival in Congestive Heart Failure (MISCHF) study.

BACKGROUND: In an ongoing study, a randomized, controlled trial is being conducted on the effects of a collaborative quality improvement program on practice patterns and patient outcomes regarding congestive heart failure (CHF) in community hospitals in upstate New York. CHF is associated with severe morbidity and mortality, with annual rates of death exceeding 50% among patients with the most severe disease. PHASE I: Phase I of the study was designed to model the processes of care and outcomes, develop valid disease-specific risk adjustment techniques, and target areas for quality improvement (QI) intervention. Beginning April 1, 1995, and ending December 31, 1995, baseline data were collected during hospitalization and for six months postdischarge for all 1,402 consecutive patients assigned diagnosis-related groups (DRGs) 127 and 124. Preliminary analyses revealed high rates of hospital readmission (46%) and postdischarge death (18%), with significant interhospital variation. QI INITIATIVES: Initiatives include educational programs on CHF, feedback of Phase I data to clinicians and administrators, design and implementation of a clinical care pathway, improvement of the emergency department (prehospital) phase of CHF management, and improvement in patient education and discharge planning. SUMMARY AND CONCLUSIONS: The study suggests that community hospitals, many without extensive experience in clinical investigation, can voluntarily collaborate to design and implement a timely QI initiative that is evidence based, clinically relevant, and scientifically sound. Preliminary results have led to better understanding of the processes of care and determinants of outcome for patients with heart failure. Phase II of the study should yield insights into the providers' response to a locally derived intervention and the effects of such a program on patient outcomes.

Cardiology Service, Hospital↗
PubMed1996

Increasing perceptions of disease vulnerability through imagery.

Increasing the cognitive availability of disease symptoms can increase perceptions of vulnerability to a fictitious disease. Research findings have also suggested that men and women respond differently to AIDS information; nevertheless, prior research has failed to examine the effects of imagery on both male and female perceptions of vulnerability to a real disease, such as AIDS. Undergraduates were presented with symptoms that were either hard to imagine or easy to imagine (labeled as related to either AIDS or hyposcenia-B) that the students then read or imagined. The results, which replicated prior research, indicated that imagining disease symptoms altered the students' perceived vulnerability to a fictitious disease. However, only imagery was significantly related to perceived vulnerability to AIDS, and gender interacted with this imagery process. Women expressed significant increases in perceived vulnerability when reading the disease symptoms, whereas men were more vulnerable when imagining the disease symptoms than they were when they read about the symptoms. The authors discuss the implications of their research for the integration of theory and experimentation in designing AIDS-intervention programs.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Physical therapist assistants' perceptions of the documented roles of the physical therapist assistant.

BACKGROUND AND PURPOSE: This study investigated physical therapist assistants' (PTAs) perceptions of the documented roles of PTAs and compared those perceptions with those of physical therapists from a previous study. SUBJECTS AND METHODS: A questionnaire that described 79 physical therapy activities was distributed to a sample (n = 400) of PTAs derived from the American Physical Therapy Association membership. The response rate was 56% (n = 225). Respondents indicated whether each activity was included in the documentation describing PTA roles. Discriminant analyses were used to determine whether demographic factors predicted the pattern of responses. In addition, meta-analytic techniques were used to determine whether PTA responses were different from those of physical therapists gathered previously. RESULTS: The greatest agreement of PTA opinions with published guidelines occurred for treatment implementation activities, and the lowest level of agreement occurred for items designated as administrative activities. Responses of PTAs were different from those of physical therapists on 21 of the 79 activities. The greatest number of these differences occurred for evaluative functions (n = 9). Physical therapist assistants' perceptions of documented PTA roles were generally less consistent with published guidelines than were those of physical therapists. CONCLUSION AND DISCUSSION: Physical therapist assistants' perceptions of the roles of the PTA were, for some activities, not consistent with written guidelines. Using the data provided in this study, discussions to revise the documentation of the scope of PTA practice may focus on those activities for which disagreement between PTAs and physical therapists exists and for which opinions differ markedly from published guidelines. [Robinson AJ, DePalma MT, McCall M. Physical therapist assistants' perceptions of the documented roles of the physical therapist assistant.

Allied Health Personnel↗
PubMed1995

A tumor-derived protein which provides T-cell costimulation through accessory cell activation.

A recently described tumor-derived glycoprotein, designated 90K, has been shown to have positive effects on the generation of cytotoxic effector cells (NK/LAK) from human PBMC. To determine the mechanism of these effects, we have examined the effects of 90K on cytokine production by human PBMC. A culture of normal PBMC with 90K alone did not result in IL-2 secretion; however, in coculture with suboptimal doses of ConA, 90K increased IL-2 secretion by PBMC. Coculture of PBMC with 90K and ConA also resulted in increased production of the cytokines IL-1, IL-6, GM-CSF, and TNF alpha. T cells depleted of accessory cells failed to respond to ConA alone, 90K alone, or the combination of ConA and 90K, suggesting that this protein does not have a direct effect on T cells. However, 90K alone was sufficient to induce cytokine production by unfractionated PBMC (IL-1, IL-6, GM-CSF, and TNF alpha) or by CD14-enriched PBMC (IL-1 and IL-6). In addition, expression of ICAM-1 was increased on a human monocytic cell line cultured with purified 90K in the absence of any other stimulus. This 90K-induced upregulation of ICAM-1 expression was accompanied by an increased accessory function of the monocytes, demonstrated by their ability to support ConA-induced activation of peripheral blood T cells. Based on the current data, we propose a model in which 90K activates accessory cells, resulting in the secretion of cytokines and the expression of adhesion molecules, which in turn act as costimulatory signals for T-cell activation. Activated T cells then produce cytokines such as IL-2, which lead to a more vigorous cell-mediated immune response to tumor cells and virus-infected cells. Thus, 90K shows promise as an immunotherapeutic reagent for diseases such as cancer and viral infection.

Antigen-Presenting Cells↗
PubMed1994

Physical therapists' perceptions of the roles of the physical therapist assistant.

BACKGROUND AND PURPOSE: This longitudinal study investigated physical therapists' perceptions of the roles of physical therapist assistants (PTAs). METHODS AND SUBJECTS: In 1986, a questionnaire describing 79 physical therapy activities was distributed to a random sample (n = 400) of physical therapists derived from the American Physical Therapy Association (APTA) membership. In 1992, a similar questionnaire was distributed to a representative sample (n = 400) of physical therapists derived from the APTA membership. Response rates were 53% and 55% in 1986 and 1992, respectively. Respondents indicated whether each activity was included in the documentation describing PTA roles. RESULTS: Results revealed considerable agreement between therapists' perceptions of PTA roles and those outlined by PTA practice guidelines, and these perceptions changed little over time. Discriminant analyses suggested that therapists' perceptions of PTA roles were, in general, not predicted by supervisory experience with PTAs, therapist experience, or content of entry-level professional education curricula. CONCLUSION AND DISCUSSION: Generally, therapists' perceptions of PTA roles are consistent with published practice guidelines. Therapists' perceptions on selected activities, however, were incongruent with PTA practice guidelines, suggesting the potential for inefficient or inappropriate utilization of the PTA in the delivery of selected services.

Allied Health Personnel↗
PubMed1994

An evaluation of three methods for determining colloid osmotic pressure.

Plasma colloid osmotic pressure (COP) is an important determinant in edema formation. Three methods for assessing the COP were evaluated. Direct measurement of COP using the 4420 Wescor Colloid Osmometer was compared to the estimation of COP from both serum total protein and total serum solids (TSS) determinations. Blood samples from twenty adult patients (mean age = 64 years) undergoing cardiopulmonary bypass surgery were collected for COP assessment. Sample collection was performed prior to heparinization/hemodilution, during hypothermic bypass and at the conclusion of bypass following protamine administration. The results obtained from each method were analyzed by a two-way analysis of variance. The Bonferroni technique was used for comparison of sample means when the difference was significant (p less than 0.05). Correlations were reported by linear regression analysis. A statistically significant difference (p less than 0.01) was found between the three methods. A regression equation for the estimation of COP from total serum solids is offered: COP = (3.02 * TSS) + 0.65. Prospective clinical testing between the direct COP measurement and the estimation of COP from TSS using the equation (n = 38) revealed a significant correlation (R2 = .932) and no significant difference between the two (p greater than 0.05).

Albumins↗
PubMed1994

Head-and-neck surgery.

Explore the source record for details and available documents.

Education, Nursing, Continuing↗
PubMed1992

Obstetric care and cesarean birth rates: a program to monitor quality of care.

OBJECTIVE: To study the quality of obstetric care in relation to rising cesarean rates, a Task Force was formed in New York state by the Department of Health and ACOG District II. The Task Force also included the Organization of Obstetric, Gynecologic, and Neonatal Nurses and the Hospital Association of New York State. The goals were to enhance hospitals' in-house review processes, standardize terminology, and improve the quality of care. A premise of the program was that if quality of care improved, cesarean rates would fall. METHODS: A Dictionary of Terms was developed to standardize clinical and diagnostic terminology. A two-tiered review process was instituted, using internal and external hospital reviews. A format for in-house review of obstetric care was developed and recommended to hospitals. External reviews were conducted at 24 hospitals during 1989-1990. Review teams, composed of obstetrician-gynecologists and obstetric nurses in active obstetric practice, assessed obstetric facilities, staffing, medical care, and the in-house review process. Contacts continued with the hospitals after site visits to follow up on implementation of recommendations. General recommendations to improve care, based on the overall program experience, were distributed to hospitals and physicians as part of educational efforts to improve quality of care. RESULTS: The state cesarean rate reversed. Statistics for 1989 and 1990 showed a stronger downward trend in reviewed hospitals than in non-reviewed hospitals. A survey of reviewed hospitals reported a positive response to the review process. CONCLUSION: A successful quality assurance program can be jointly developed by a state regulatory agency and a medical specialty society.

Cesarean Section↗
PubMed1988

Fetal heart rate monitoring by telephone. II. Clinical experience in four centres with a commercially produced system.

A commercially produced domiciliary fetal monitoring (DFM) system was assessed in four centres in the UK (Bristol, Glasgow, London and Nottingham) chosen to allow for comprehensive assessment in various settings in many different women. Overall, 825 recordings were made from 368 women (2.24 per woman). There were 56 unsuccessful attempts at transmission (6.8%), most were due to problems with telephone equipment. The system worked most efficiently when a dedicated direct line was used. The data transmission time varied between 40 and 60 s. The median telephone time (including data transmission and conversation) with a dedicated direct line was 7 min. Mean acceptance times from the four centres were between 70 and 80%. All recordings with acceptance times of 40% or more were interpretable. Ten recordings were abnormal. The women and mid-wives were equally proficient at using the DFM system. The DFM system represents an important addition to current methods of fetal assessment. Specific guidelines are outlined.

England↗