Biomedical subjects

M Wilson

Publications and source records attributed to M Wilson.

At least 127 records · Page 7Linked to original sources

PubMed2001

The Interdisciplinary Generalist Curriculum (IGC) project: an overview of its experience and outcomes.

The Interdisciplinary Generalist Curriculum (IGC) Project was a competitive, seven-year demonstration project funded by the Health Resources and Services Administration (HRSA). It was established to determine whether specific interdisciplinary innovations in preclinical medical school curricula could affect students' selection of careers in family medicine, general internal medicine, or general pediatrics. Through collaboration among the three generalist disciplines, the IGC innovation exposed all preclinical students in ten demonstration schools to a new or significantly enhanced preclinical curriculum that included a direct supervised clinical experience with a generalist physician preceptor. The project was managed by an interdisciplinary executive committee that was codirected by one representative each from family medicine, general internal medicine, and general pediatrics. A national advisory committee with representation from the academic and professional organizations of family medicine, internal medicine, pediatrics, and osteopathy provided input to the executive committee in guiding the project. The project was externally evaluated. Major outcomes of the IGC Project include sustained curricular changes in ten institutions, prompted by relatively few dollars and demonstration of models for collaboration at institutional and national levels. This supplement describes the IGC Project's experience and outcomes so that others may draw pertinent information to apply to their own efforts in medical education.

Curriculum↗

PubMed2001

Implementation of the Interdisciplinary Generalist Curriculum Project: considerations of structure, funding, and design.

Implementation of the Interdisciplinary Generalist Curriculum (IGC) Project involved complex processes that reflect structural, funding, and intervention design considerations. Among structural considerations, the IGC Project benefited from a national structure above the level of the demonstration schools. Governance by committee was highly effective because it harnessed and balanced power. At the national level, governance by committee was enhanced by strong central coordination, and it had a role-modeling effect for governance at the school level. The IGC experience over the seven-year course of the project suggests that it is important to revisit the role of a national advisory committee over time and to revise that role as warranted. Funding considerations, including the importance of funding evaluation for a period of time long enough to measure intended impacts and the length and amount of funding to demonstration schools, are discussed. Prescription of the IGC intervention and the focus on years one and two of medical education are critical design considerations. The authors conclude that the IGC Project used relatively few federal dollars to demonstrate a highly prescribed intervention in a limited number of medical schools toward a clear and limited goal. IGC lessons apply to programs specifically targeting primary care education, but also to other medical school curricular innovations, and perhaps, to a larger framework of multi-site educational interventions.

Curriculum↗

PubMed2001

Curricular change: recommendations from a national perspective.

Recommendations on future directions, funding, and organizational and curricular issues have emerged from the complexity of the Interdisciplinary Generalist Curriculum (IGC) Project. For example, future demonstration projects aimed at innovations in medical education that are funded through the contracting mechanism are recommended, and funding intended to serve as institutional leverage for demonstrating desired curricular innovations in medical education is encouraged. Funding provided to entities that can maximize influence within the institutions is recommended. Also, the period of time over which funds are provided needs to take into consideration the breadth of the impact of the funded program on the larger curriculum and the length of time needed to measure desired outcomes. Organizational findings are that multi-site projects with administrative oversight bodies should be governed by representatives of concerned disciplines who have stakes in the demonstration of the innovations in medical education, and roles of the executive and advisory committees involved in the effort need to be made explicit at the onset and revisited over time. Similarly, the role of the funder needs to be explicit. Curricular recommendations are that medical schools are encouraged to develop longitudinal generalist preceptorship experiences early in medical education for all students, regardless of their eventual career choices. Schools should anticipate that curricular innovations in the preclinical years may require modifications of the educational process in the clinical years.

Curriculum↗

PubMed2001

Congenital toxoplasmosis: a review.

Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. In the United States, approximately 85% of women of childbearing age are susceptible to acute infection with T. gondii. Acute infections in pregnant women may cause serious health problems when the organism is transmitted to the fetus (congenital toxoplasmosis), including mental retardation, seizures, blindness, and death. An estimated 400 to 4000 cases of congenital toxoplasmosis occur in the U.S. each year. Manifestations of congenital toxoplasmosis may not become apparent until the second or third decade of life. Serologic tests are used to diagnose acute infection in pregnant women, but false-positive tests occur frequently, therefore, serologic diagnosis must be confirmed at a reference laboratory before treatment with potentially toxic drugs should be considered. Much of congenital toxoplasmosis can be prevented by educating women of childbearing age and pregnant women to avoid eating raw or undercooked meat, to avoid cross-contamination of other foods with raw or undercooked meat, and to use proper cat-litter and soil-related hygiene.

Animals↗

PubMed2001

Some current research in rotating-disc systems.

Rotating-disc systems are used to model the flow and heat transfer that occurs inside the cooling-air systems of gas-turbine engines. In this paper, recent computational and experimental research in three systems is discussed: rotor-stator systems, rotating cavities with superposed flow and buoyancy-induced flow in a rotating cavity. Discussion of the first two systems concentrates respectively on pre-swirl systems and rotating cavities with a peripheral inflow and outflow of cooling air. Buoyancy-induced flow in a rotating cavity is one of the most difficult problems facing computationalists and experimentalists, and there are similarities between the circulation in the Earth's atmosphere and the flow inside gas-turbine rotors. For this case, results are presented for heat transfer in sealed annuli and in rotating cavities with an axial throughflow of cooling air.

Journal Article↗

PubMed2001

Transfer of TN916-like elements in microcosm dental plaques.

Microcosm dental plaques were grown from an inoculum of human saliva in a constant-depth film fermentor. The inoculum contained four tetracycline-resistant streptococcal species, each of which contained a Tn916-like element. This element was shown to transfer to other streptococci both in filter-mating experiments and within the biofilms in the fermentor.

Biofilms↗

PubMed2001

Simplified assay for measuring Toxoplasma gondii immunoglobulin G avidity.

A Toxoplasma gondii immunoglobulin G (IgG) avidity enzyme-linked immunosorbent assay (ELISA) was developed that combines the accuracy of assays based on end point titers and the relative ease of assays based on optical density values. Like published procedures, the new assay's avidity index (AI) was based on differential T. gondii-specific IgG reactivity in serum-treated wells washed with urea buffer versus that in wells washed with control buffer; unlike previous assays, however, the IgG reactivity was measured quantitatively using a standard curve. The assay was evaluated using 24 IgG-positive and IgM-positive sera collected within 5 months of the onset of symptoms (recent-infection group) and 25 IgG-positive and IgM-negative sera (past-infection group). All sera in the recent-infection group exhibited AI values of <0.18, whereas all sera in the past-infection group exhibited AI values of >0.27. The AI values of the recent-infection group showed significant correlation with the number of days after the onset of symptoms. A subset of 16 sera (8 recent and 8 past) was tested using a commercially available T. gondii IgG avidity ELISA based on end point titration; the results of the two assays showed highly significant correlation (R(2) = 0.9125). In addition, we confirmed and extended the findings of other investigators, showing that AI values calculated using optical density values, but not AI values calculated using quantitative IgG values, varied significantly depending on the serum dilution used. This new assay should facilitate the accurate measurement of T. gondii IgG avidity in a reference laboratory setting.

Animals↗

PubMed2001

Identification of the exported proteins of the oral opportunistic pathogen Actinobacillus actinomycetemcomitans by using alkaline phosphatase fusions.

A phoA fusion library of Actinobacillus actinomycetemcomitans genomic DNA has been screened to identify genes encoding exported and secreted proteins. A total of 8,000 colonies were screened, and 80 positive colonies were detected. From these, 48 genes were identified with (i) more than half having homology to known or hypothetical Haemophilus influenzae genes, (ii) 14 having no ascribed function, and (iii) 4 having very limited or no homology to known genes. The proteins encoded by these genes may, by virtue of their presence on the cell surface, be novel virulence determinants.

Aggregatibacter actinomycetemcomitans↗

PubMed2001

Global transcriptional response of Bacillus subtilis to heat shock.

In response to heat stress, Bacillus subtilis activates the transcription of well over 100 different genes. Many of these genes are members of a general stress response regulon controlled by the secondary sigma factor, sigma(B), while others are under control of the HrcA or CtsR heat shock regulators. We have used DNA microarrays to monitor the global transcriptional response to heat shock. We find strong induction of known sigma(B)-dependent genes with a characteristic rapid induction followed by a return to near prestimulus levels. The HrcA and CtsR regulons are also induced, but with somewhat slower kinetics. Analysis of DNA sequences proximal to newly identified heat-induced genes leads us to propose ~70 additional members of the sigma(B) regulon. We have also identified numerous heat-induced genes that are not members of known heat shock regulons. Notably, we observe very strong induction of arginine biosynthesis and transport operons. Induction of several genes was confirmed by quantitative reverse transcriptase PCR. In addition, the transcriptional responses measured by microarray hybridization compare favorably with the numerous previous studies of heat shock in this organism. Since many different conditions elicit both specific and general stress responses, knowledge of the heat-induced general stress response reported here will be helpful for interpreting future microarray studies of other stress responses.

Arginine↗

PubMed2001

Quantitative diffusion weighted magnetic resonance imaging, cerebral atrophy, and disability in multiple sclerosis.

OBJECTIVES: To investigate the relations between quantitative diffusion coefficient MRI histograms, clinical variables, and cerebral atrophy. METHODS: Twenty two patients with clinically definite multiple sclerosis and 11 healthy volunteers were studied. Histograms of apparent diffusion coefficient (ADC) from a volume of interest that included multiple slices encompassing the lateral ventricles were processed from diffusion weighted MRI. In addition, total lesion load was measured on T2 weighted dual echo images, and cerebral volume from 3D magnetisation prepared rapid acquisition gradient echo scans. All patients underwent neurological assessment, including disability on the expanded disability status scale (EDSS). RESULTS: Histograms from the patient group showed a reduced peak height and a "right shift" compared with healthy controls. Peak height of the diffusion histogram correlated with both EDSS (r=-0.54, p=0.0101) and disease duration (r=-0.52, p=0.0140), but not with age. Brain volume correlated with peak height of the ADC histogram (r=0.55, p=0.0129), but not with disability. Total lesion load also correlated moderately with EDSS (r=0.46, p=0.03). CONCLUSIONS: This study shows for the first time that quantitative MRI measures of diffusion correlate with clinical variables (disability, disease duration) and cerebral atrophy in multiple sclerosis. Cerebral atrophy and fixed neurological deficit may be attributed to axonal loss, which would be expected to have a significant effect on ADC. Extension of this method to more patients and longitudinal studies will further elucidate its sensitivity, reproducibility, and potential role in clinical practice and treatment trials.

Adult↗

PubMed2001

Pulmonary (99m)Tc-DTPA aerosol clearance and survival in usual interstitial pneumonia (UIP).

BACKGROUND: Clearance of inhaled technetium 99m-labelled diethylenetriamine penta-acetic acid ((99m)Tc-DTPA) from the lungs is a potential indicator of disease progression in patients with idiopathic pulmonary fibrosis (IPF). METHODS: We prospectively analysed the usefulness of this technique for predicting survival in 106 non-smoking patients with usual interstitial pneumonia (UIP) pattern IPF diagnosed by high resolution CT (HRCT) scanning or histological examination (M/F 65/41, mean (SD) age 61 (11) years). DTPA clearance was analysed according to both mono-exponential and bi-exponential models. Half times for the fast (t(0.5)F) and slow (t(0.5)S) components of clearance, the percentage contribution of the fast component (fF), and half time for mono-exponential approximation to the early part of the clearance curve (t(0.5)) were calculated. RESULTS: The patients had substantially faster t(0.5) (mean 23.9 (9.6) minutes) than normal values (>45 minutes). Thirty seven patients (35%) died during follow up (median 15 months). Univariate Cox regression analysis identified significant predictors of survival as age, forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), total lung capacity (TLC), % predicted TLC, carbon monoxide transfer factor (TLCO), % predicted TLCO, arterial oxygen tension (PaO(2)), oxygen saturation, t(0.5)F, and HRCT fibrosis score. Multiple stepwise Cox regression analysis identified t(0.5)F (p=0.03, hazard ratio 0.747, 95% CI 0.578 to 0.964), % predicted TLC (p=0.02, hazard ratio 0.976, 95% CI 0.956 to 0.995), % predicted TLCO (p=0.003, hazard ratio 0.960, 95% CI 0.935 to 0.986), and age (p=0.003, hazard ratio 1.062, 95% CI 1.021 to 1.104) as independent predictors of survival. CONCLUSION: These data suggest that (99m)Tc-DTPA clearance t(0.5)F measurement may predict survival in patients with UIP pattern IPF.

Aged↗

PubMed2001

Survey of obstetrician-gynecologists in the United States about toxoplasmosis.

BACKGROUND: Although the incidence of toxoplasmosis is low in the United States, up to 6000 congenital cases occur annually. In September 1998, the Centers for Disease Control and Prevention held a conference about toxoplasmosis; participants recommended a survey of the toxoplasmosis-related knowledge and practices of obstetrician-gynecologists and the development of professional educational materials for them. METHODS: In the fall of 1999, surveys were mailed to a 2% random sample of American College of Obstetricians and Gynecologists (ACOG) members and to a demographically representative group of ACOG members known as the Collaborative Ambulatory Research Network (CARN). Responses were not significantly different for the random and CARN groups for most questions (p value shown when different). RESULTS: Among 768 US practicing ACOG members surveyed, 364 (47%) responded. Seven per cent (CARN 10%, random 5%) had diagnosed one or more case(s) of acute toxoplasmosis in the past year. Respondents were well-informed about how to prevent toxoplasmosis. However, only 12% (CARN 11%, random 12%) indicated that a positive Toxoplasma IgM test might be a false-positive result, and only 11% (CARN 14%, random 9%) were aware that the Food and Drug Administration sent an advisory to all ACOG members in 1997 stating that some Toxoplasma IgM test kits have high false-positive rates. Most of those surveyed (CARN 70%, random 59%; chi2 p < 0.05) were opposed to universal screening of pregnant women. CONCLUSIONS: Many US obstetrician-gynecologists will encounter acute toxoplasmosis during their careers, but they are frequently uncertain about interpretation of the laboratory tests for the disease. Most would not recommend universal screening of pregnant women.

Acute Disease↗

PubMed2001

Thermal capsular shrinkage for shoulder instability. Mid-term longitudinal outcome study.

We present the short- and medium-term clinical results of thermal shrinkage in selected groups of patients with multidirectional or capsular stretch-type instability. We treated 56 patients (61 shoulders) by laser-assisted capsular shrinkage (LACS) and 34 patients (38 shoulders) by radiofrequency (RF) capsular shrinkage. The two groups were followed for mean periods of 40 months and 23 months, respectively. In the LACS group the mean Walch-Duplay score improved to 90 points 18 months after the operation, but then declined to a plateau of about 80 points; 59% of patients considered their shoulders to be 'much better' or 'better' but there was a failure rate of 36.1%. For the RF group the mean Walch-Duplay and Constant scores were 80 points at the various follow-up times; 76.3% of patients considered their shoulder to be 'much better' or 'better'. RF failed in nine shoulders (23.7%). These results match some clinical series of patients with multidirectional instability, undergoing open inferior capsular shift, with a similar rate of failure. We believe that the minimal morbidity involved makes thermal shrinkage a viable alternative to open capsular shift in this difficult group of patients.

Adolescent↗

PubMed2001

How to obtain uniformity of occlusal detail.

At a recent Primary Dental Care Editorial Board meeting it was suggested that a series of short articles providing practical advice on clinical procedures might well be appreciated by our readers. This, then, is an invitation to our readers to submit material of this type, for publication. The text may be kept brief by the use of illustrations. The following example is the type of communication that we have in mind, but any information of a practical nature about the use of dental products would be carefully considered. We are grateful to the publishers of Fenestra (3M Dental Products) and the authors for permission to republish this piece first published in 1999.

Dental Impression Materials↗

PubMed2001

Vertex/propagator model for least-scattered photons traversing a turbid medium.

The least-scattered photons that arrive at a detector through highly scattering tissues have the potential to image internal structures, functions, and status with high imaging resolution. In contrast, optical diffusing tomography is based on the use of the late-arriving photons, which have been diffusely scattered, leading to very low imaging resolution. A good model of the early-arriving photons, i.e., the least-scattered photons, may have a significant effect on the development of imaging algorithms and a further understanding of imaging mechanisms within current high-resolution optical-imaging techniques. We describe a vertex/propagator approach that attempts to find the probabilities for least-scattered photons traversing a scattering medium, based on analytical expressions for photon histories. The basic mathematical derivations for the model are outlined, and the results are discussed and found to be in very good agreement with those from the Monte Carlo simulations.

Journal Article↗

PubMed2001

Antibodies anti-Chlamydia pneumoniae and anti-Mycoplasma pneumoniae in patients with negative serology for hantavirus. Retrospective study.

The seroprevalence of Chlamydia pneumoniae and Mycoplasma pneumoniae in hantavirus seronegative patients, who had symptoms and signs compatible with pneumonia was established. For this purpose we used the indirect fluorescent antibody test. Titers > or = 1:16 for C. pneumoniae and M. pneumoniae were found in 8.6% and 17.1% of the serum, respectively, showing evidence of recent or current infection.

Adolescent↗

PubMed2001

Bacterial biofilms and human disease.

The term biofilm is used to denote a polymer-encased community of microbes which accumulates at a surface. Biofilms are responsible for a number of diseases of man and, because of the intrinsic resistance of these structures to antibiotics and host defence systems, such diseases are very difficult to treat effectively. The application of new microscopic and molecular techniques to biofilms has revolutionised our understanding of their structure, composition, organisation and activities. This review will describe the role that biofilms play in human disease and will outline our new millennial view of these complex and fascinating bacterial communities.

Antibiotic Prophylaxis↗

PubMed2001

The case for sensorimotor coding in working memory.

The highly influential Baddeley and Hitch model of working memory (Baddeley & Hitch, 1974; see also Baddeley, 1986) posited analogical forms of representation that can be broadly characterized as sensorimotor, both for verbal and for visuospatial material. However, difficulties with the model of verbal working memory in particular have led investigators to develop alternative models that avoid appealing either to sensory coding or to motoric coding, or to both. This paper examines the evidence for sensorimotor coding in working memory, including evidence from neuropsychology and from sign language research, as well as from standard working memory paradigms, and concludes that only a sensorimotor model can accommodate the broad range of effects that characterize verbal working memory. In addition, several findings that have been considered to speak against sensorimotor involvement are reexamined and are argued to be in fact compatible with sensorimotor coding. These conclusions have broad implications, in that they support the emerging theoretical viewpoint of embodied cognition.

Attention↗