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Biomedical subjects

M Smith

Publications and source records attributed to M Smith.

At least 343 records · Page 19Linked to original sources
PubMed1998

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in ED record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product. Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

Emergency Service, Hospital↗
PubMed1998

Patient-related barriers to pain management in ambulatory AIDS patients.

A number of studies have demonstrated that pain is dramatically undertreated among patients with AIDS and that opioids in particular are rarely prescribed. To date, however, there has been no systematic attempt to examine patient-related barriers to the management of pain in AIDS. This study examines potential patient-related barriers to pain management in patients with AIDS using the Barriers Questionnaire (Ward et al., Pain, 52 (1993) 319-324), and assesses gender, racial, and other demographic differences in the endorsement of these barriers. We surveyed 199 ambulatory patients with AIDS, recruited from numerous sites in New York City, as part of an ongoing study of pain and quality of life in ambulatory AIDS patients. In addition to obtaining demographic and medical data, we administered a number of self-report questionnaires including the Brief Pain Inventory (BPI), the Brief Symptom Index (BSI), the Beck Depression Inventory (BDI), and the Memorial Symptom Assessment Scale (MSAS). Barriers to pain management were assessed using a modified version of the Barriers Questionnaire (BQ), including the original 27 questions from this self-report instrument along with an additional 12 items developed for an AIDS population. Results indicated that the most frequently endorsed BQ items were those concerning the addiction potential of pain medications and physical discomfort associated with opioid administration (e.g. injections) or side effects (e.g. nausea, constipation). There were no associations between age, gender, or HIV transmission risk factor and total scores on the BQ; however, Caucasian patients endorsed significantly fewer BQ items than did non-Caucasian patients and years of education was negatively correlated with BQ scores. Scores on the BQ were also significantly correlated with number of physical symptoms (MSAS) and scores on several self-report measures of psychological distress (the BSI Global Distress Index, BDI total scores). Patient-related barriers (i.e. BQ total scores) were significantly associated with undertreatment of pain (as measured by the Pain Management Index), and added significantly to the prediction of undertreatment in a logistic regression analysis, even after controlling for the impact of gender, education and IDU transmission risk factor. These data suggest that patient-related barriers to pain management may add to the already considerable likelihood of undertreatment of AIDS-related pain.

Acquired Immunodeficiency Syndrome↗
PubMed1998

MRI nerve root enhancement in Krabbe disease.

Krabbe disease is characterized by abnormal breakdown and turnover of myelin, leading to extensive demyelination in both the peripheral and central nervous systems. A 7-month-old infant with early-onset Krabbe disease had deceptively normal head images, but spinal MRI demonstrated abnormal gadolinium enhancement of the lumbosacral sacral nerve roots and cauda equina such as that seen in Guillain-Barré syndrome. Abnormal enhancement in spinal MRI has not been previously described in patients with leukodystrophies.

Cauda Equina↗
PubMed1998

Recommendations for training in performance and interpretation of stress echocardiography. Committee on Physician Training and Education of the American Society of Echocardiography.

Stress echocardiography has emerged as a clinically useful procedure in the management of patients with ischemic heart disease and other conditions. However, the accuracy of this test relies on the ability of those who carry out the technical aspects of the test and depends critically on proper interpretation of the images. Appreciation of wall motion abnormalities is generally acknowledged as one of the most difficult skills to master in echocardiography. There is consensus that this is also one of the most difficult skills to teach. Appreciating stress-induced changes in wall motion, which sometimes are subtle, requires a significant commitment to initial training in this skill and its maintenance. This document provides recommendations for physician training in stress echocardiography.

Cardiology↗
PubMed1998

The European Union Concerted Action World Wide Web site for Lyme borreliosis.

This web site (URL http://www.dis.strath.ac.uk/vie/LymeEU/) provides information on Lyme borreliosis for physicians, scientists, health care workers, veterinarians and students. It consists of a review of the spirochaetes, vectors, reservoir hosts, diagnosis, treatment, epidemiology and prevention of the disease, as well as an account of the activities of EUCALB.

Computer Communication Networks↗
PubMed1998

Complete assignment of 1H, 13C and 15N chemical shifts for bovine beta-lactoglobulin: secondary structure and topology of the native state is retained in a partially unfolded form.

Although beta-lactoglobulin (beta-LG) has been studied extensively for more than 50 years, its physical properties in solution are not yet understood fully in terms of its three-dimensional (3D) structure. For example, despite a recent high-resolution crystal structure, it is still not clear why the two common variants of bovine beta-LG which differ by just two residues have different aggregation properties during milk processing. We have conducted solution-state NMR studies on a recombinant form of the A variant of beta-LG at low pH conditions where the protein is partially unfolded and exists as a monomer rather than a dimer. Using a 13C, 15N-labelled sample, expressed in Pichia pastoris, we have employed the standard combination of 3D heteronuclear NMR techniques to obtain near complete assignments of proton, carbon and nitrogen resonances. Using a novel pulse sequence we were able to obtain additional assignments, in particular those of methyl groups in residues preceding proline within the sequence. From chemical shifts and on the basis of inter-residue NOEs, we have inferred the secondary structure and topology of monomeric beta-LG A. It includes eight antiparallel beta-strands arranged in a barrel, flanked by an alpha-helix, which is typical of a member of the lipocalin family. A detailed comparison with the crystal structure of the dimeric form (for a mixture of A and B variants) at pH 6.5 reveals a close resemblance in both secondary structure and overall topology. Both forms have a ninth beta-strand which, at the higher pH, forms part of the dimer interface. These studies represent the first full NMR assignment of beta-LG and will form the basis for a complete characterisation of the solution structure and dynamics of this protein and its variants.

Amino Acid Sequence↗
PubMed1998

RAS, FMS and p53 mutations and poor clinical outcome in myelodysplasias: a 10-year follow-up.

The molecular mechanisms underlying the development and evolution of myelodysplastic syndrome (MDS) are largely unknown. The increasing number of blast cells in the bone marrow correlate with poor prognosis and risk of developing acute leukemia. Such progression is frequently associated with increasing chromosomal abnormalities and genetic mutations. A cohort of 75 MDS patients were investigated for RAS, FMS and p53 mutations, and these molecular findings were related to cytogenetics, clinical status, transformation to acute leukemia, prognostic scores and survival. A mutation incidence of 57% (43/75) was found, with 48% (36/75) RAS mutations, 12% (9/75) FMS mutations and 8% (4/50) p53 mutations. The mutation status for RAS and FMS was related to MDS subgroup, increasing with poor-risk disease. The highest incidence was in the chronic myelomonocytic leukemia (CMML) subgroup. The most frequent RAS mutations were of codon 12 and a predominance of FMS codon 969 mutations was observed. A statistically significant increased frequency of transformation to AML was observed in MDS patients harboring RAS or FMS mutations (P < 0.02). Patients with oncogene mutations had a significantly poorer survival compared with those without mutations at 2 years and at the end of the period of follow-up (P < 0.02). Multivariate analysis including mutation, age, gender, diagnosis (FAB), cytogenetics and International score shows that the International score and mutation and age is the best predictive model of a poor outcome, (P < 0.0001). When the analysis was undertaken without the International score, mutation and gender was the best predictor of poor survival (P = 0.005). This study shows that oncogene mutation, indicative of genetic instability, is associated with disease progression and poor survival in MDS.

Adult↗
PubMed1998

Chemical modification of isoflavones in soyfoods during cooking and processing.

The principal chemical forms of isoflavones in soybean are their 6''-O-malonyl-beta-glucoside (6OMalGlc) conjugates. Experiments were carried out to determine the best conditions for extraction of isoflavones from soyfoods and the effects of commercial processing procedures and of cooking on isoflavone concentrations and composition. Hot alcohol extraction of ground soybeans deesterified 6OMalGlc conjugates. Although room temperature extraction slowed the conversion, extraction at 4 degrees C for 2-4 h led to the highest yield of 6OMalGlc conjugates and the lowest proportion of beta-glucoside conjugates. Analysis of soyfood products by reversed-phase HPLC-mass spectrometry revealed that defatted soy flour that had not been heat treated consisted mostly of 6OMalGlc conjugates; in contrast, toasted soy flour contained large amounts of 6''-O-acetyl-beta-glucoside conjugates, formed by heat-induced decarboxylation of the malonate group to acetate. Soymilk and tofu consisted almost entirely of beta-glucoside conjugates; low-fat versions of these products were markedly depleted in isoflavones. Alcohol-washed soy-protein concentrates contained few isoflavones. Isolated soy protein and textured vegetable protein consisted of a mixture of all 3 types of isoflavone conjugates. Baking or frying of textured vegetable protein at 190 degrees C and baking of soy flour in cookies did not alter total isoflavone content, but there was a steady increase in beta-glucoside conjugates at the expense of 6OMalGlc conjugates. The chemical form of isoflavones in foods should be taken into consideration when evaluating their availability for absorption from the diet.

Chromatography, High Pressure Liquid↗
PubMed1998

Standards for psychological services in long-term care facilities.

Psychologists in Long-Term Care (PLTC), a national network established in 1983, has developed, with input from colleagues and consumers, standards for psychological practice in long-term care facilities. These standards address provider characteristics, methods of referral, assessment practices, treatment, and ethical issues. This article describes the document's development and offers suggestions for its use.

Geriatric Assessment↗
PubMed1998

How best to measure implementation of school health curricula: a comparison of three measures.

The impact of school health education programs is often attenuated by inadequate teacher implementation. Using data from a school-based nutrition education program delivered in a sample of fifth graders, this study examines the discriminant and predictive validity of three measures of curriculum implementation: class-room observation of fidelity, and two measures of completeness, teacher self-report questionnaire and post-implementation interview. A fourth measure, obtained during teacher observations, that assessed student and teacher interaction and student receptivity to the curriculum (labeled Rapport) was also obtained. Predictive validity was determined by examining the association of implementation measures with three study outcomes; health knowledge, asking behaviors related to fruit and vegetables, and fruit and vegetable intake, assessed by 7-day diary. Of the 37 teachers observed, 21 were observed for two sessions and 16 were observed once. Implementation measures were moderately correlated, an indication of discriminant validity. Predictive validity analyses indicated that the observed fidelity, Rapport and interview measures were significantly correlated with post-test student knowledge. The association between health knowledge and observed fidelity (based on dual observation only), Rapport and interview measures remained significant after adjustment for pre-test knowledge values. None of the implementation variables were significantly associated with student fruit and vegetable intake or asking behaviors controlling for pre-test values. These results indicate that the teacher self-report questionnaire was not a valid measure of implementation completeness in this study. Post-implementation completeness interviews and dual observations of fidelity and Rapport appear to be more valid, and largely independent methods of implementation assessment.

Child↗
PubMed1998

Spinal cord injury incidence in Mississippi: a capture-recapture approach.

BACKGROUND: Many studies have investigated spinal cord injury incidence rates. Few, however, have adjusted for the underascertainment. The current study used the capture-recapture method to estimate the ascertainment-corrected spinal cord injury incidence rate in Mississippi. METHODS: Two sources were used for case ascertainment: Mississippi's spinal cord injury registry and hospital reports. The two-sample capture-recapture method was used to adjust for undercount. RESULTS: Two hundred one spinal cord injuries were reported to or found by the Mississippi State Department of Health in 1993, with a crude incidence rate of 7.8 per 100,000 population per year among hospital admissions and prehospital fatalities. Using the two-sample capture-recapture method, it is estimated that the incidence rate would be 9.3 per 100,000 population per year. CONCLUSION: Capture-recapture estimates suggest that Mississippi's spinal cord injury incidence rate is more than twice the national average.

Epidemiologic Methods↗
PubMed1998

"A satellite primer on tuberculosis:" a collaboration in distance education.

"A Satellite Primer on Tuberculosis" was offered as a distance-based certificate course on tuberculosis (TB) fundamentals to a national audience of over 5,000 individuals. The course was a collaborative effort of a school of public health, a state health department, and the Centers for Disease Control and Prevention. Instruction was provided through print-based self-study modules that were complemented by live, interactive satellite conferences. Course completers, over 70 percent of whom were nurses and employees of public health departments, scored significantly higher on a course posttest than on a pretest, and the vast majority felt the course provided valuable training.

Curriculum↗
PubMed1998

Tandem organization and highly disparate expression of the two laccase genes lcc1 and lcc2 in the cultivated mushroom Agaricus bisporus.

Two non-allelic laccase genes (lcc1 and lcc2) in Agaricus bisporus have been mapped to the same cosmid clone and are close together, in tandem. The intergenic region consists of 1562 bp between the stop codon of lcc1 and the start codon of lcc2. Differences between the 5' non-coding regions of the two genes suggest the potential for their differential regulation. By employing competitive RT-PCR and specific primer pairs that discriminate between lcc1 and lcc2, it has been shown that the level of lcc2 mRNA is approximately 300 times higher than that of lcc1 mRNA in malt extract liquid cultures; in compost cultures lcc2 mRNA is almost 7000 times more abundant than lcc1 mRNA.

Agaricus↗