Biomedical subjects
M Smith
Publications and source records attributed to M Smith.
Pulling the plug.
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Find the value in people.
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Up and down the decision tree.
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Dentists' responses to drug misusers.
A survey among a sample of illicit drug misusers in 1993 indicated under-use of dental services, in spite of a high prevalence of dental problems, whilst a survey of dentists revealed reluctance to treat such patients. Most dentists use additional infection control procedures when they detect 'at-risk' patients, but their screening procedures are unlikely to be effective. Most dentists in the survey would welcome extra training focused on drug misuse.
The role of emotionality and regulation in children's social functioning: a longitudinal study.
Multiple measures of children's emotionality (emotional intensity and negative affectivity), regulation (including attentional and behavioral regulation and coping), and social functioning (teachers' reports of nonaggressive/socially appropriate behavior and prosocial/socially competent behavior; and parents' reports of problem behavior) were obtained for 6-8-year-olds. In addition, emotionality, attentional regulation, and coping were assessed 2 years previously. Social functioning was expected to be predicted by low negative emotionality and high levels of regulation. In general, the data supported the predictions, although the findings for parent reports of problem behavior were primarily for boys. Prediction of social functioning from measures of regulation and emotionality occurred primarily within a given context (school vs. home) rather than across contexts, even though there were relations across reporters within the school or home context. In addition, vagal tone, a marker of physiological regulation, was positively related to competent social functioning and emotionality/regulation for boys, but inversely related for girls.
Successful selection of the case manager.
What are the factors necessary to consider when selecting the case manager role? This article presents a fresh perspective on selection practices necessary to successfully fill this pivotal position. Expected role outcomes, required knowledge, skill, and values; and key staff to involve in the process provide a framework to assist the nurse leader to establish case management to succeed from the start.
Effect of race on survival following in-hospital cardiopulmonary resuscitation.
BACKGROUND: Race has been shown to be a significant predictive factor in a number of treatment decisions and outcomes, including survival following out-of-hospital cardiopulmonary resuscitation (CPR). The goal of this study was to determine whether race is associated with the rate of survival to discharge following in-hospital CPR. METHODS: Consecutive adult patients undergoing attempted CPR at three teaching hospitals were identified. Demographic, clinical, and laboratory data from the time of admission, information about the resuscitation attempt, and the outcome of CPR were recorded for each patient. The characteristics of black and non-black patients were compared. Logistic regression was used to determine whether race was a significant independent predictor of CPR outcome. RESULTS: A total of 656 patients were identified. Black patients had a higher mean severity of illness as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) III score, were more likely to have an initial rhythm of electromechanical dissociation or asystole, were less likely to have an admitting diagnosis of myocardial infarction or a history of coronary artery disease, and had a higher serum creatinine level, lower serum albumin value, and lower 24-hour urine output for the first 24 hours. There was no difference between black and nonblack patients regarding the rate of survival of the resuscitative effort itself. However, black patients were significantly less likely than nonblack patients to survive to discharge following resuscitation (Mantel-Haenszel odds ratio, 0.31; 95% confidence interval, 0.15 to 0.68). This relationship persisted after adjusting for potential confounders such as age, sex, initial cardiac rhythm, diagnosis of pneumonia, serum creatinine level, hospital, and APACHE III score. CONCLUSIONS: Black race is significantly associated with a lower rate of survival to discharge following in-hospital CPR. Further work is needed to explore this association in other settings; to examine the effect of other possible confounding variables, such as tobacco use, socioeconomic status, and marital status; and to further study the determinants of physician decision-making about resuscitation.
Domestic violence: recognition, intervention, and prevention.
Domestic violence is a significant social and health problem that has received intensive recent publicity in the lay media. Nurses should play a major role in primary, secondary, and tertiary prevention interventions. Intensified health promotion and public policy initiatives can reduce the incidence of domestic violence in the future.
Report on Jenni: positive progression.
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t(9;22)(q22-31;q11-12) is a consistent marker of extraskeletal myxoid chondrosarcoma: evaluation of three cases.
Three cases of extraskeletal myxoid chondrosarcoma with typical histologic and ultrastructural features were investigated cytogenetically. All three cases showed a reciprocal chromosome translocation characterized as t(9;22)(q22-31)(q11-12), thus confirming the findings in three previously karyotyped cases of extraskeletal myxoid chondrosarcoma in the literature. These data add significantly to the evidence of t(9;22) being diagnostic for extraskeletal myxoid chondrosarcoma. Other previously published cases with a range of complex karyotypes were less well defined morphologically. In cases with limited diagnostic material this karyotype might facilitate distinction from myxoid liposarcoma, which consistently shows t(12;16). Clear cell sarcoma, Ewing's sarcoma/primitive neuroectodermal tumor, and desmoplastic round cell tumor also show involvement of chromosome 22 with formation of a hybrid gene between the Ewing's sarcoma gene on band q12 and a transcription factor gene. Whether rearrangement of the Ewing's sarcoma gene is also present in extraskeletal myxoid chondrosarcoma is not clear at present. Cloning of the (9;22) translocation might provide important clues to the pathogenesis of this type of chondrosarcoma.
Pulse methylprednisolone in rheumatoid arthritis: effects on peripheral blood and synovial fluid neutrophil surface phenotype.
OBJECTIVE: To determine the effects of a 1000 mg intravenous pulse of methylprednisolone (MP) on the expression of cell adhesion molecules on peripheral blood and synovial fluid (SF) neutrophils in rheumatoid arthritis. METHODS: Fluorescent flow cytometric analysis was performed on peripheral blood neutrophils (n = 13 patients) and knee joint SF neutrophils (n = 7 patients) prior and at 4 and 24 h after MP. Clinical and laboratory assessments of disease activity were performed. RESULTS: There was marked improvement in all clinical stores at 24 h including a decrease in pain score (p < 0.0005), stiffness (p < 0.00005), joint tenderness score and modified Health Assessment Questionnaire (HAQ) (p < 0.005), and an increase in well being (p < 0.001). At 24 h there was a significant decrease in SF neutrophil counts to mean (SEM) of 31.5% (15%) of baseline and an increase in peripheral blood neutrophils to a mean (SEM) of 199% (25%) of baseline. Furthermore, a significant decrease was observed in the expression of both structural and functional epitopes of CD11b (p < 0.05) and CD18 (p < 0.05) on SF neutrophils at both 4 and 24 h post-MP. There was also an increase in the expression of L-selectin (CD62L), which approached significance (p = 0.01), but no significant effect on CD11a, CD44 and sialyl Lewisx (CD15s). Peripheral blood neutrophils showed decreased expression of CD11b (p = 0.1), CD18 (p = 0.07), and L-selectin (p = 0.09), which approached statistical significance without any associated effects on CD11a, CD15s, or CD44. CONCLUSION: MP is associated with a marked decrease in CD11b and CD18 expression on SF neutrophils and, to a lesser extent, peripheral blood neutrophils. This may be due to decreased neutrophil activation as these cells traffic from the vasculature through the synovial membrane or to decreased activation in the synovial space.
Reduction in accumulation of plaque, stain, and calculus in dogs by dietary means.
We conducted 215 evaluations for plaque, stain, and calculus in 120 dogs at two research sites. Dogs were balanced in groups of five according to baseline plaque index scores; groups were randomly assigned to treatment or control dietary regimens. Dental cleanings were done on Day 0. Dogs in the treatment group were fed a food formulated to reduce accumulation of plaque, stain, and calculus. Control group dogs were fed a commercially available dry dog food. No other foods, treats, or snacks were given to either group. We graded 22 teeth for plaque accumulation on Day 7 and for stain and calculus accumulation on Day 21. Six trials were conducted and the results reported as a combined mean for all treatment and control groups. Dogs fed the treatment food had significantly less plaque, stain, and calculus accumulation (p = 0.001) than dogs fed the control food. Plaque, stain, and calculus accumulation can be reduced by dietary means.
Rupture of the mitochondrial outer membrane impairs porin assembly.
Outer membranes isolated from yeast mitochondria were capable mediating the in vitro insertion of porin. As with the outer membrane of intact mitochondria, the insertion was ATP-dependent, and the inserted porin was resistant to trypsin treatment after detergent solubilization. However, the extent of porin insertion into isolated outer membranes was much less per mg of outer membrane protein than with intact mitochondria. The greater efficiency of intact mitochondria was not due to contact site-mediated translocation as isolated contact sites were less able to insert porin than isolated outer membranes, and blockade of the contact site channel in intact mitochondria did not affect porin insertion. However, mitochondria that had been subjected to osmotic shock sufficient to rupture the outer membrane and deplete the contents of the intermembrane space (i.e. mitoplasts) lost most of their ability to insert porin. Since outer membranes are isolated from mitoplasts, the low insertion activity of mitoplasts explains the low efficiency of insertion into isolated outer membranes. These results also indicate that, unlike proteins that are imported to the inner membrane and matrix of the mitochondria, porin's assembly is severely reduced by breaching the outer membrane and depletion of the intermembrane space contents.
Environmental lead and children's intelligence: a systematic review of the epidemiological evidence.
OBJECTIVE: To quantify the magnitude of the relation between full scale IQ in children aged 5 or more and their body burden of lead. DESIGN: A systematic review of 26 epidemiological studies since 1979: prospective studies of birth cohorts, cross sectional studies of blood lead, and cross sectional studies of tooth lead. SETTING: General populations of children > or = 5 years. MAIN OUTCOME MEASURES: For each study, the regression coefficient of IQ on lead, after adjustment for confounders when possible, was used to derive the estimated change in IQ for a specific doubling of either blood or tooth lead. RESULTS: The five prospective studies with over 1100 children showed no association of cord blood lead or antenatal maternal blood lead with subsequent IQ. Blood lead at around age 2 had a small and significant inverse association with IQ, somewhat greater than that for mean blood lead over the preschool years. The 14 cross sectional studies of blood lead with 3499 children showed a significant inverse association overall, but showed more variation in their results and their ability to allow for confounders. The seven cross sectional studies of tooth lead with 2095 children were more consistent in finding an inverse association, although the estimated magnitude was somewhat smaller. Overall synthesis of this evidence, including a meta-analysis, indicates that a typical doubling of body lead burden (from 10 to 20 micrograms/dl (0.48 to 0.97 mumol/l) blood lead or from 5 to 10 micrograms/g tooth lead) is associated with a mean deficit in full scale IQ of around 1-2 IQ points. CONCLUSION: While low level lead exposure may cause a small IQ deficit, other explanations need considering: are the published studies representative; is there inadequate allowance for confounders; are there selection biases in recruiting and following children; and do children of lower IQ adopt behaviour which makes them more prone to lead uptake (reverse causality)? Even if moderate increases in body lead burden adversely affect IQ, a threshold below which there is negligible influence cannot currently be determined. Because of these uncertainties, the degree of public health priority that should be devoted to detecting and reducing moderate increases in children's blood lead, compared with other important social detriments that impede children's development, needs careful consideration.