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Biomedical subjects

M Miller

Publications and source records attributed to M Miller.

At least 163 records · Page 9Linked to original sources
PubMed2000

Nocturnal polyuria in older people: pathophysiology and clinical implications.

OBJECTIVES: To review the physiological changes of aging which affect the systems involved in urine formation and to consider how these changes interact with changes in bladder function, thereby leading to the onset of nocturnal polyuria with associated urinary frequency, nocturia, and incontinence. Based on this information, data are presented on the effectiveness of pharmacological interventions which reduce the rate of urine formation and, thus, can be of benefit in reducing symptoms, especially during the nighttime. METHODS: Peer-reviewed journal articles were identified by MEDLINE Search and by review of the literature. CONCLUSIONS: As a consequence of age-associated diminished renal concentrating capacity, diminished sodium conserving ability, loss of the circadian rhythm of antidiuretic hormone secretion, decreased secretion of renin-angiotensin-aldosterone, and increased secretion of atrial natriuretic hormone, there is an age-related alteration in the circadian rhythm of water excretion leading to increased nighttime urine production in older people. The interaction of nocturnal polyuria with age-related diminution in functional bladder volume and detrusor instability results in the symptoms of urinary frequency, nocturia and, in some persons, incontinence. The additional impact of Alzheimer's disease on these physiological and aging changes, as well as on a diminished perception of bladder fullness, leads to an even greater risk of urinary incontinence in these patients. Treatment of nocturnal polyuria with the antidiuretic hormone analog, DDAVP (desmopressin), can result in decreased nocturnal urine production with improvement in symptoms of frequency, nocturia, and incontinence.

Age Factors↗
PubMed2000

Gun use in the United States: results from two national surveys.

OBJECTIVES: To determine the relative incidence of gun victimization versus self defense gun use by civilians in the United States, and the circumstances and probable legality of the self defense uses. METHODS: National random digit dial telephone surveys of the adult population were conducted in 1996 and 1999. The Harvard surveys appear unique among private surveys in two respects: asking (1) open ended questions about defensive gun use incidents and (2) detailed questions about both gun victimization and self defense gun use. Five criminal court judges were asked to assess whether the self reported defensive gun uses were likely to have been legal. RESULTS: Even after excluding many reported firearm victimizations, far more survey respondents report having been threatened or intimidated with a gun than having used a gun to protect themselves. A majority of the reported self defense gun uses were rated as probably illegal by a majority of judges. This was so even under the assumption that the respondent had a permit to own and carry the gun, and that the respondent had described the event honestly. CONCLUSIONS: Guns are used to threaten and intimidate far more often than they are used in self defense. Most self reported self defense gun uses may well be illegal and against the interests of society.

Firearms↗
PubMed2000

CEP-1347 inhibits caerulein-induced rat pancreatic JNK activation and ameliorates caerulein pancreatitis.

Pancreatic caerulein-induced activation of c-Jun NH(2)-terminal kinase (JNK) has been reported, and JNK has been proposed as a mediator during induction of hyperstimulated pancreatitis. CEP-1347 has recently been described as a specific JNK inhibitor. We tested whether CEP-1347 inhibits caerulein-induced pancreatic JNK activation in isolated acini and in vivo. CEP-1347 dose dependently inhibited acinar caerulein-induced JNK activation with nearly complete inhibition at 2 microM but had no effect on digestive enzyme release. For in vivo studies, rats were pretreated with CEP-1347 before caerulein hyperstimulation. For assessment of JNK activation and histological alterations, animals were killed 30 min or 2 and 4 h after caerulein hyperstimulation, respectively. Pancreatic wet weight, serum enzyme levels, and pancreatic activity of p38 and extracellular signal-regulated kinase (ERK) were also determined. Caerulein hyperstimulation strongly activated JNK, p38, and ERK. CEP-1347 pretreatment dose dependently reduced caerulein-induced pancreatic JNK activation without p38 or ERK inhibition. JNK inhibition also reduced pancreatic edema formation and reduced histological severity of pancreatitis. Thus we show that CEP-1347 inhibits JNK activation in vivo and ameliorates caerulein-induced pancreatitis.

Amylases↗
PubMed2000

The relation between baseline HIV drug resistance and response to antiretroviral therapy: re-analysis of retrospective and prospective studies using a standardized data analysis plan.

To assess the relation between resistance to antiretroviral drugs for treatment of HIV-1 infection and virological response to therapy, results from 12 different studies were re-analysed according to a standard data analysis plan. These studies included nine clinical trials and three observational cohorts. The primary end-point in our analyses was virological failure by week 24. Baseline factors that were investigated as predictors of virological failure were plasma HIV-1 RNA, the number and type of new antiretroviral drugs in the regimen, and viral susceptibility to the drugs in the regimen, determined by genotyping or phenotyping methods. These analyses confirmed the importance of both genotypic and phenotypic drug resistance as predictors of virological failure, whether these factors were analysed separately or adjusted for other baseline confounding factors. In most of the re-analysed studies, the odds of virological failure were reduced by about twofold for each additional drug in the regimen to which the patient's virus was sensitive by genotyping methods, and by about two- to threefold for each additional drug that was sensitive by phenotyping.

Anti-HIV Agents↗
PubMed2000

Ulcerative colitis.

Ulcerative colitis is a relatively common cause of altered bowel habit and rectal bleeding. Coordinated management of the investigation and care of patients with this condition is vital to optimize treatment. This article reviews current management options.

Adult↗
PubMed2000

Are household firearms stored safely? It depends on whom you ask.

OBJECTIVE: To determine gun storage practices in gun-owning households with children. DESIGN: National random digit-dial telephone survey of 2521 households conducted in March 1999 through July 1999. This study uses a subsample of 434 households with children <18 years old in which a respondent reported either: 1) personally owning a gun, or 2) living in a gun-owning household but not owning a gun themselves. Respondents were asked whether any household gun was currently stored loaded, and, if yes, whether any gun was currently stored loaded and unlocked. RESULTS: Twenty-one percent of gun owners compared with 7% of non-owners reported that a household gun was stored loaded, while 9% and 2%, respectively, reported that a household gun was stored loaded and unlocked. Non-gun owners were significantly more likely than were gun owners to be female (87% vs 22%) and to report that they lived in a house with only 1 gun (70% vs 57%) and no handguns (51% vs 31%). Based on the reports of actual gun owners (n = 252), households with children <13 years old were significantly less likely to store a gun loaded and unlocked (multivariate odds ratio:.1; 95% confidence interval:.0,.4) than were households with teenagers only. CONCLUSIONS: We find that among gun-owning households with children, non-gun owners report significantly lower rates of guns stored loaded and unlocked than do gun owners. These findings are consistent with recent studies that have found that married men are far more likely to report household gun ownership than are married women, and that gun users are far more likely to report that a gun is stored loaded or loaded and unlocked than are never users. Our findings suggest that non-gun owners, the vast majority of whom are women (87%), may be unaware that guns in their homes are stored in a manner that experts agree is unsafe. Our findings reinforce the importance of many pediatricians' current efforts to offer anticipatory guidance about firearms to gun-owning families, and, in addition, suggest that this guidance can be adapted depending on whether the physician is speaking with a gun-owning or non-gun-owning parent. In particular, because gun owners (mostly fathers) are less likely to bring children to the pediatrician's office than are non-owners (mostly mothers), physicians should take advantage of any opportunities that they have to address gun-related issues with parents who personally own guns. More commonly, physicians can encourage non-gun owners to participate more fully in household decision-making about gun storage by letting them know not only about recommended storage practices, but also that many non-owners may not know how guns are actually stored in their own homes. firearm, storage, children, survey.

Chi-Square Distribution↗
PubMed2000

Venomous snakebites in an urban area: what are the possibilities?

OBJECTIVE: To estimate the number of different species of venomous snakes privately kept in a large urban area. METHODS: An anonymous survey of potential snake owners in the Philadelphia urban and suburban area. The survey was mailed to members of the Philadelphia Herpetological Society. In addition, the survey was published in 2 herpetological newsletters and online in the Herpetology Network. RESULTS: One hundred sixty responses were obtained during a 6-month period. Ownership of 74 different varieties of venomous snakes was reported. Antivenin was not locally available for 13 of these species. CONCLUSION: A wide variety of venomous captive snakes can be found in the private sector. The potential for having to treat an envenomation requires the emergency physician to maintain an education of snakebite management options, including the various antivenin options available in their geographical location.

Animals↗
PubMed2000

Cigarettes and suicide: a prospective study of 50,000 men.

OBJECTIVES: This study examined the relation between smoking and suicide, controlling for various confounders. METHODS: More than 50,000 predominantly White, middle-aged and elderly male health professionals were followed up prospectively with biennial questionnaires from 1986 through 1994. The primary end point was suicide. Characteristics controlled for included age, marital status, body mass index, physical activity, alcohol intake, coffee consumption, and history of cancer. RESULTS: Eighty-two members of the cohort committed suicide during the 8-year follow-up period. In age-adjusted analyses with never smokers as the comparison group, the relative risk of suicide was 1.4 (95% confidence interval [CI] = 0.8, 2.3) among former smokers, 2.6 (95% CI = 0.9, 7.5) for light smokers (< 15 cigarettes/day), and 4.5 (95% CI = 2.3, 8.8) among heavier smokers. After adjustment for potential confounders, the relative risks were 1.4 (95% CI = 0.9, 2.4), 2.5 (95% CI = 0.9, 7.3), and 4.3 (95% CI = 2.2, 8.5), respectively. CONCLUSION: We found a positive, dose-related association between smoking and suicide among White men. Although inference about causality is not justified, our findings indicate that the smoking-suicide connection is not entirely due to the greater tendency among smokers to be unmarried, to be sedentary, to drink heavily, or to develop cancers.

Adult↗
PubMed2000

An interactive CD-ROM for nutrition screening and counseling.

OBJECTIVES: The goal of this project was to develop an interactive CD-ROM for nutrition screening and counseling, designed to produce dietary behavior change in fat and fruit and vegetable intake. METHODS: The design was based on principles of relevance to the learner, readiness for change, feedback, individualization, facilitation of skills, and goal setting. It was tested in community settings such as libraries, senior centers, and Women, Infants, and Children clinics. RESULTS: Nearly 80% of the respondents (n = 284), including numerous low-income persons, reported learning something new about nutrition and health or their own dietary habits. More than 50% of those recontacted 2 to 4 weeks later had put some of their dietary goals into practice. CONCLUSIONS: This program is useful for dietary screening, feedback, skill building, and motivation in settings in which in-person counseling by nutrition professionals is not feasible.

Adult↗
PubMed2000

An integrated program for evidence-based medicine in medical school.

To provide optimal care for their patients, clinicians must be able to locate and interpret the most current literature. Teaching the necessary skills to medical students is essential, if we wish to train clinicians to be able to keep up with the expansion of biomedical knowledge for their entire working lives. In this paper, we describe our school's four-year curriculum in evidence-based medicine and the performance of three senior classes on the summative evaluation exercise devised to measure the program's success.

Curriculum↗
PubMed2000

Evaluation of the cellular uptake of hexitol nucleic acids in HeLa cells.

Two major hurdles to the widespread use of synthetic nucleic acids as drugs are the biological stability of the compounds and efficiency of cellular penetration. Recent advances in the chemistry of nucleic acids has given rise to highly stable derivatives with an anhydrohexitol backbone. This report addresses the cellular uptake of these molecules. We show that the uptake of HNA in the absence of a carrier is very low but HNA is efficiently internalized with a range of transfection reagents.

Fluorescent Dyes↗
PubMed2000

Multicentre research and the WISECARE experience. Workflow Information Systems for European Nursing Care.

The benefits of collaborative research are becoming recognized increasingly within the profession of nursing due to the associated increased likelihood of funding, variety of practice settings and increased access to resources that collaboration brings. While such benefits have made collaborative research one of the most desirable strategies for achieving the goals of research, the potential problems of language and communication, culturally sensitive instruments, access to subjects, availability of technology and lack of research resources have complicated collaborative international research initiatives. Review of the literature, although encouraging such initiatives, does little to provide information regarding the processes involved in multinational collaboration or the associated advantages and disadvantages to guide those embarking on such large scale, multinational, cross-cultural studies. The diverse meanings of collaboration within research initiatives further hamper this understanding. Positive definitions focus on aspects such as sharing expertise, making a valuable contribution to the research and ultimately shared ownership of the accomplishments of the research. One such research project led by nurses was the WISECARE project. WISECARE (Workflow Information Systems for European Nursing Care) was funded by the European Commission and aimed to improve cancer nursing practice and ultimately patient outcomes through the integration and utilization of state of the art information technology. Such a project was developed as a result of nursing's apparent invisibility within health care delivery and the problems experienced by nurses in articulating their worth within an increasingly cost-conscious health care system. Oncology care was selected as the domain for the project not only because this speciality of nursing already has an established network of nurses throughout Europe in the European Oncology Nursing Society (EONS) but also because the practice of cancer nursing encompasses all aspects of nursing care. This paper will address the advantages and disadvantages associated with collaboration, using the WISECARE project as an example.

Communication Barriers↗
PubMed1999

Mosaic trisomy 7 in a patient with pigmentary abnormalities.

Somatic chromosomal mosaicism may present as isolated pigmentary abnormalities or multiple congenital anomalies with mental retardation. Pigmentary lesions are visually dramatic and are differentiated based on appearance when the underlying pathogenesis is not known. It is now clear that mosaicism is responsible for the pigmentary findings in hypomelanosis of Ito (HI) and linear and whorled nevoid hypermelanosis (LWH). Both hypopigmentation and hyperpigmentation have been noted in the same individual, and both LWH and HI can be caused by similar chromosomal abnormalities. Both of these conditions exhibit similar systemic involvement. We present a case of LWH associated with mosaic trisomy 7 and review the relevant literature.

Child, Preschool↗