Ethnography and the evaluation of needle exchange in the prevention of HIV transmission.
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Connecticut↗
Biomedical subjects
M Singer
Publications and source records attributed to M Singer.
Synthesis and 5-lipoxygenase inhibitory activities of some novel 2-substituted 5-benzofuran hydroxamic acids.
A series of 2-substituted benzofuran hydroxyamic acids were synthesized as rigid analogs of simple (benzyloxy)phenyl hydroxamates, evaluated for their in vitro and in vivo 5-lipoxygenase activity and found to be potent inhibitors of the enzyme. Substituents which enhanced lipophilicity near the 2-position of the benzofuran nucleus increased inhibitor potency but reduced oral activity. Incorporation of small polar substituents such as methoxymethylene, hydroxymethylene, and amino (urea) on the acyl group led to more consistent oral activity. The most potent inhibitors of this series in vitro were N-hydroxy-N-[1-(2-phenyl-5-benzofuranyl)-ethyl]furancarboxamide (12) and methyl 5-[N-hydroxy-N-[1-(2-(3,4,5-trimethoxyphenyl)-5-benzofuranyl]ethyl]-5- oxopentanoate (17), both with IC50 values of 40 nM, and in vivo the most potent compound was N-hydroxy-N-[1-(2-phenyl-5-benzofuranyl)ethyl]urea, 20, with an ED50 = 10.3 mg/kg.
Animals↗
Bacterial sporulation. An ATP/ADP switch.
Regulatory factors that initiate forespore-specific transcription during Bacillus subtilis sporulation respond to adenosine nucleotide ratios.
Adenosine Diphosphate↗
Heparin clearance during continuous veno-venous haemofiltration.
OBJECTIVE: To determine whether premature clotting of haemofiltration circuits could be related to heparin removal across the filter membrane into the ultrafiltrate. DESIGN: Randomised study using either unfractionated (n = 8) or low molecular weight (n = 7) heparin for anticoagulation of the haemofiltration circuit at 1000 and 600 U/h respectively. Samples were drawn at 1 and 2 h from arterial and venous limbs of the haemofilter circuit for measurement of plasma heparin (as anti-Factor Xa activity), antithrombin III and haematocrit. Ultrafiltrate samples were collected at the same time for measurement of anti-Xa activity. SETTING: Intensive care unit. PATIENTS: Patients in acute renal failure requiring haemofiltration. RESULTS: Both unfractionated and low molecular weight heparin plasma levels were within the range required for therapeutic anticoagulation in all but one patient at 2 h. Ultrafiltrate anti-Xa levels were insignificant. Antithrombin III levels in these critically ill patients were subnormal in 11 of the 15 studies. CONCLUSIONS: Despite their small sizes, neither unfractionated nor low molecular weight heparins cross the haemofilter membrane into the ultrafiltrate in any measurable quantity. Both heparins were present in plasma at a level suitable for therapeutic anticoagulation. Subnormal levels of antithrombin III may be an important factor in determining filter longevity.
Acute Kidney Injury↗
The cost of intensive care: a comparison on one unit between 1988 and 1991.
OBJECTIVE: To assess the changes in cost of intensive care in one unit after a 3 year period and to evaluate the relative costs of an integrated high dependency unit. DESIGN: Combined retrospective and prospective audit of all expenditure incurred in an intensive care/high dependency unit over two periods: April 1988-February 1989 and January-July 1991. SETTING: Combined 13-bedded intensive care/high dependency unit of a central London teaching hospital. RESULTS: The overall cost rose by 50%. Hidden costs such as infrastructure maintenance, capital assets, pathology and radiology services accounted for nearly a quarter of total expenditure. Pharmacy and supplies each accounted for some 10% of total expenditure whereas staff costs exceeded 50%. The cost of the intensive care section rose by 14% of 1149 pounds per patient day as increased bed occupancy offset increases in nurse: patient ratios and expenditure on consumables. However, the cost of the high dependency unit section rose by 87% to 437.83 pounds. This was due to a lower bed occupancy (through increased patient turnover), improved staffing ratios, and increased utilisation of equipment and supplies. CONCLUSIONS: Intensive care is an increasingly expensive speciality, the costs for which are rising over and above the rate of general inflation. Staff costs are by far the largest single item of expenditure. Large reductions in spending on drugs and consumables are unlikely to provide considerable savings on the total budget. Hidden costs account for a high proportion of the budget and should be taken into account when evaluating cost. The significantly lower cost of high dependency care should encourage studies into its cost-effectiveness.
Health Services Research↗
AIDS and the health crisis of the U.S. urban poor; the perspective of critical medical anthropology.
The social identity of HIV/AIDS in the U.S. has been shaped, for the most part, by two factors, the prevailing configuration of social relations across class, racial, gender, and sexual orientation, on the one hand, and the prevailing array of public health, especially epidemiological, categories of disease transmission, on the other. Focusing on the AIDS epidemic among inner city people of color, this paper challenges the distortions wrought in our understanding from both of these factors and instead develops an alternative perspective for AIDS research among medical anthropologists and health social scientists generally.
Acquired Immunodeficiency Syndrome↗
The politics of AIDS. Introduction.
From its first designation as a gay plague, HIV/AIDS has been a heavily politicized disease, a disease that has fractured official standard operating procedures in science, medicine, public health and governance. In many ways, AIDS helped to expose a battleground of contested interests while emerging as an arena for both the re-assertion of 'traditional' (i.e. dominant) values as well as rebellion against the traditional politics of exclusion and privilege. Yet the politics of AIDS has remained an understudied domain. This set of papers seeks to overcome this neglect by exploring underlying political dimensions of the AIDS pandemic, especially in the way the pandemic has been constructed by epidemiology, biomedicine, and medical anthropology. Authored by a group of medical anthropologists and an anthropologically oriented political scientist, the papers provide a jarring glimpse at the profound influence of society on health and disease.
Acquired Immunodeficiency Syndrome↗
Cardiovascular performance and core temperature during transurethral prostatectomy.
Hemodynamic performance and core temperature were recorded during transurethral prostatectomy in 52 patients who were stratified according to cardiac symptom score and then randomized to undergo standard (31) or isothermic (21) transurethral prostatectomy. During the standard procedure ambient temperature (21C) irrigant was used, while during isothermic prostatectomy warmed irrigant at 38C was used to prevent heat loss from the bladder, and a warming blanket and humidifying filter were used to decrease cutaneous and respiratory heat loss. Core temperature decreased by a mean of 0.8C (95% confidence interval -0.9 to -0.7) during standard transurethral prostatectomy and by 0.27C (-0.4 to -0.15) during the isothermic procedure. The standard prostatectomy group showed a significant hemodynamic response consisting of increased mean arterial pressure (p < 0.0002), increased index of systemic vascular resistance (p < 0.0001), bradycardia (p < 0.02), and decreased Doppler indexes of stroke volume (p < 0.005) and cardiac output (p < 0.001). The isothermic transurethral prostatectomy group was hemodynamically stable. These differences between the groups suggest that rapid central cooling exerted a significant effect on perioperative hemodynamic performance during transurethral prostatectomy.
Aged↗
Novel bishydroxamic acids as 5-lipoxygenase inhibitors.
Two series of novel bishydroxamic acids 2 and 3 (types A and B) were synthesized and tested for inhibition of 5-lipoxygenase from rat basophile leukemia (RBL) cells. Both series were potent inhibitors of the isolated enzyme but only the type B reverse hydroxamic acids possessed significant oral activity. The most potent compound, orally, was 3a, [IC50 = 270 nM; ED50 = 1.86 mg/kg], which compares favorably with the clinically useful 5-lipoxygenase inhibitor, zileuton. Unlike known hydroxamic acid inhibitors, the oral activity in this series appears to be associated with the second hydroxamic acid group. The corresponding monohydroxamic acids retained inhibitor potency, in vitro, with reduced oral activity in a mouse zymosan peritonitis model. Compound 4e [IC50 = 7 nM], a monohydroxamic acid derivative related to 3a, is among the most potent inhibitors of the isolated enzyme yet to be reported.
Animals↗
Constructing inferences during narrative text comprehension.
The authors describe a constructionist theory that accounts for the knowledge-based inferences that are constructed when readers comprehend narrative text. Readers potentially generate a rich variety of inferences when they construct a referential situation model of what the text is about. The proposed constructionist theory specifies that some, but not all, of this information is constructed under most conditions of comprehension. The distinctive assumptions of the constructionist theory embrace a principle of search (or effort) after meaning. According to this principle, readers attempt to construct a meaning representation that addresses the reader's goals, that is coherent at both local and global levels, and that explains why actions, events, and states are mentioned in the text. This study reviews empirical evidence that addresses this theory and contrasts it with alternative theoretical frameworks.
Cognition↗
Pharyngoesophageal reconstruction using the radial forearm fasciocutaneous free flap: preliminary results.
Pharyngoesophageal reconstruction remains a challenge to the head and neck surgeon. The goals of pharyngoesophageal reconstruction include restoration, with minimal morbidity, of a person's ability to swallow and to speak. Myocutaneous flaps, gastric pull-up, and the jejunal free flap are popular methods of pharyngoesophageal reconstruction; however, none of these modalities is clearly ideal. We have begun utilizing the radial forearm fasciocutaneous free flap for pharyngoesophageal reconstruction. Twelve patients have had reconstruction with this flap with follow-up from 2 to 15 months. Seven defects were circumferential, and five were noncircumferential. Ten patients (83%) have had successful restoration of both swallowing ability and voice. Donor site morbidity was minimal. The leading complication was salivary leak, which was present in eight (67%) patients. Five of the leaks closed with nonsurgical intervention. No cases of flap necrosis occurred. The radial forearm free flap is a thin and pliable flap that closely approximates the tissue consistency of normal pharynx. Successful restoration of a patient's ability to swallow approximates that of enteral flaps and is superior to that of MC flaps. Successful speech restoration is superior to that of enteral and MC flaps. Donor site morbidity is less than that caused by enteral flaps because laparotomy is avoided. Salivary leak is higher than with enteral flaps. Part of this difference is accountable to the high number of secondary and technically challenging reconstructions in this series, and we have taken steps to lower this rate of leakage. These preliminary data show that the radial forearm fasciocutaneous free flap is well suited for pharyngoesophageal reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Hemodynamic effects of manual hyperinflation in critically ill mechanically ventilated patients.
SUBJECT OBJECTIVE: To assess the hemodynamic effects of manual lung hyperinflation in mechanically ventilated patients and to measure the different inspiratory pressures and tidal volumes generated by different operators. DESIGN: Measurements of aortic blood flow (by esophageal Doppler ultrasonography), systemic blood pressure, tidal volumes (by respirometry), and inspiratory pressures in the ventilator circuit were measured on the ventilator, during six intended manual hyperinflations (tidal volume > 150% that delivered by ventilator) using a 2-L rebreathing bag, and at 1, 5, 10, and 15 min after reconnection to the ventilator. SETTING: Intensive care unit. PATIENTS: Eighteen mechanically ventilated patients with normovolemia and stable circulatory status were assessed on a total of 20 occasions. INTERVENTIONS: Patients were disconnected from the ventilator to enable six manual hyperinflations to be given. Measurements were made before and at 5-min intervals until no further hemodynamic changes were seen. MEASUREMENTS AND RESULTS: Hyperinflation (50% increase in tidal volume) was achieved only in 10 of 20 studies. Large variations were seen in percentage change in peak inspiratory pressure (-30% to +250%) and tidal volume (-33% to +127%) generated. Falls in cardiac output correlated to the increase in tidal volume but not to the increase in peak inspiratory pressure and took up to 15 min to recover to baseline values. Changes in cardiac output were independent of lung compliance and concurrent vasoactive drug support. No consistent change was noted in either blood pressure or heart rate. CONCLUSIONS: Lung hyperinflation is frequently not achieved by the manual technique. Significant changes in cardiac output can occur and appear to be related to the tidal volume rather than pressure generated.
Adult↗
Dracula. Disorders of the self and borderline personality organization.
It has been proposed that Bram Stoker's novel Dracula can best be understood as a dramatic, hyperbolic, and fantastic expression of themes consistent with contemporary psychoanalytic conceptions of borderline personality disorder organization. Such an understanding may, in turn, shed further light on the nature of the intrapsychic world and experiences of borderline patients. Excerpts from the novel can be used to support the conceptualization of recent contributions to object relations theory and the understanding of borderline personality organization. It is uncanny how consistent Dracula's characteristics are to the generally seen complaints of patients suffering from this disorder.
Borderline Personality Disorder↗
A profile of specific psychotherapeutic actions for borderline psychopathology. Psychotherapeutic psychoanalysis.
This article has attempted to catalog additions to the psychotherapeutic armamentarium in the treatment of borderline personality disorder based on their conceptual linkage with new paradigms derived from contemporary developments in psychoanalysis. These new therapeutic actions have broadened and increased our therapeutic skills and are now also viewed as essential for bringing about change in patients with severe developmental arrests. The term psychotherapeutic psychoanalysis is suggested to encompass this unique cluster of intrinsic and extrinsic treatment factors within the framework of psychoanalysis.
Borderline Personality Disorder↗
Genetic evidence for the interaction between cluster I and cluster III rifampicin resistant mutations.
Rifampicin-resistant (Rifr) mutations of Escherichia coli map to the central portion of the rpoB gene, which encodes the beta subunit of RNA polymerase. These mutations are located in three distinct clusters, designated I, II and III. Three intragenic suppressors of the cluster III Rifr mutation, rpoB3406(RH687), restore the ability of the mutant strain to grow at low and high temperatures and map to a single locus in cluster I. These suppressors are identical to two previously characterized Rifr alleles, rpoB3401(RC529) and rpoB3402(RS529). None of the other 14 previously identified Rifr mutations that we have characterized confers this phenotype. We suggest that this allele-specific suppression results from interaction between Cluster I and Cluster III of the beta subunit.
Alleles↗
Infections due to antibiotic-resistant gram-positive cocci.
Gram-positive cocci are becoming increasingly resistant to traditionally used antimicrobial agents. Staphylococcus aureus, coagulase-negative staphylococci, the enterococcus, and Streptococcus pneumoniae are the most commonly encountered of such pathogens in clinical practice. Clinicians should be keenly aware of the usual types of infections that are caused by these organisms and the importance of documenting susceptibilities of infecting strains. The basic mechanisms of resistance should be familiar to clinicians so that an inappropriate empiric regimen will not be selected (e.g., addition of a beta-lactamase inhibitor for penicillin-resistant pneumococci). Vancomycin remains the agent of choice, sometimes in combination with gentamicin and/or rifampin, for most cases of infection due to these resistant gram-positive organisms. Last, increased efforts toward prevention, such as strict adherence to infection control measures, selective use of broad-spectrum antibiotics, and increased use of pneumococcal vaccine, may be useful to help stem the rising tide of infections due to resistant gram-positive cocci.
Anti-Bacterial Agents↗
Knowledge for use: anthropology and community-centered substance abuse research.
The anthropological world has changed. The ethnographic Other is no longer available and pliant, awaiting anthropological representation, but has acquired a voice of his/her own. As a result, anthropology is faced with a dilemma. What is to be the anthropological role in this transformed world? Two alternatives are examined. The first, postmodernism, stresses the development of experimental ethnographic texts that inscribe the voice of the transformed Other. Noting the weaknesses of the postmodern 'solution,' this paper proposes community-centered research as a more appropriate response to contemporary social realities. In this approach, the anthropologist seeks collaboration with the Other in the struggle for self-determination. Illustration is provided with the case study of anthropologists employed in a Puerto Rican community based organization (CBO), with specific reference to the emergence and development of the substance abuse prevention and treatment work of this CBO. While noting the difficulties of this role, the paper argues that scholarly activism, a model adopted from the Third World, is well suited to the postmodern world.
Alcoholism↗
Continuous intravenous infusion of fentanyl: case reports of use in patients with advanced cancer and intractable pain.
The use of continuous intravenous infusion of opioids may be efficacious in managing pain related to advanced cancer. Short-acting opioids, such as morphine and hydromorphone, are commonly used. We describe the use of a fentanyl infusion in four cases. This experience suggests that fentanyl may be considered an alternative drug for infusion in the treatment of refractory cancer pain.
Adult↗