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Biomedical subjects

P Gould

Publications and source records attributed to P Gould.

At least 19 recordsLinked to original sources

The hierarchical diffusion of AIDS and violent crime among U.S. metropolitan regions: inner-city decay, stochastic resonance and reversal of the mortality transition.

Census data on migration within and between the 25 largest U.S. metropolitan areas-containing more than 113 million people-permit construction of a probability-of-contact matrix corresponding to a particular Markov process dominated by the nation's largest cities, a hierarchical structure. Regression models based on vectors associated with that process find the large-scale diffusion of AIDS in the U.S.A. depends strongly on national patterns of contact with the original AIDS outbreaks in New York City and San Francisco as modulated by the violent crime rate, a local index of social disintegration resulting from the marginalization of minority ethnic urban communities. Violent crime is itself undergoing a recognizably similar hierarchical diffusion from the largest U.S. cities into smaller metropolitan regions. Further analysis suggests that continuation of public policies of "benign neglect" and "planned shrinkage" directed against marginalized urban populations may trigger a strong stochastic resonance which can significantly degrade public health and public order for much of the three-quarters of the U.S. population living in or near cities, in effect reversing the mortality transition of the last century.

Acquired Immunodeficiency Syndrome

Perforated duodenal ulcer in a pediatric patient with eosinophilic gastroenteritis.

An 11-year-old boy with eosinophilic gastroenteritis treated by an elimination diet alone presented with a perforated gastroduodenal ulcer subsequent to blunt trauma to the abdomen. Peripheral eosinophilia, chronic iron deficiency, chronic hypoalbuminemia and severe failure to thrive had been present since age 2 years. Immunological work-up revealed food allergies, documented by skin tests. A review of the literature since 1966 revealed only six other cases of perforation of the gastrointestinal tract, one of whom was also a child.

Aged

Feasibility of five courses of pre-operative chemotherapy in patients with resectable adenocarcinoma of the oesophagus or gastrooesophageal junction.

The purpose of this study was to examine the feasibility of administering all chemotherapy pre-operatively to patients with resectable adenocarcinoma of the oesophagus or gastrooesophageal junction. 32 patients with potentially resectable adenocarcinoma of the oesophagus or gastrooesophageal junction were studied in a stepwise fashion in which combination chemotherapy with cisplatin, high-dose arabinoside and 5-fluorouracil was administered. In the first part, 15 patients were to receive three chemotherapy courses pre-operatively and two chemotherapy courses postoperatively. In the second part, the next 15 patients were to receive all five chemotherapy courses pre-operatively, provided there was an objective response after three courses. Endoscopic ultrasonography was also performed, when feasible, prior to chemotherapy and surgery, and in some patients sequentially between chemotherapy courses. All of the 14 assessable patients in the first group tolerated all three courses of pre-operative chemotherapy, and 86% of patients in this group completed all protocol chemotherapy. In the second group, 9 of 18 (50%) assessable patients tolerated all five courses of preoperative chemotherapy, and 100% of patients in this group received all protocol chemotherapy. The median number of chemotherapy courses for the entire group (32 patients) was five (range one to five). Forty-one per cent (13/32) of patients had a major response to chemotherapy. Sixty-nine per cent (or 76% of 29 patients taken to surgery) had a curative resection. One patient had a pathological complete response. The median survival time of 32 patients was 17 months (range 2-36+ months). 14 patients (37%) remain alive at a median follow-up time of 26+ months. There was a correlation between endoscopic ultrasonographic tumour and nodal stage and pathological tumour and nodal stages in 16 patients. The tumour stage correlation was higher (75%) than the nodal stage correlation (62%). Our data suggest that it is feasible to administer five courses of cisplatin-based chemotherapy to patients with potentially resectable adenocarcinoma of the oesophagus or gastrooesophageal junction. More effective chemotherapy regimens that might result in higher pathological complete response rates and acceptable toxic effects are needed.

Adenocarcinoma

Will AIDS be contained within U.S. minority urban populations?

Recent empirical research, and a simple stochastic modeling exercise, suggest that affluent suburban communities are at increased risk for the diffusion of HIV from present inner city epicenters, while the 'core group' construct of sexually transmitted disease theory suggests, somewhat counter-intuitively, that the hypercongregated and strongly self-interacting nature of affluent heterosexual elites in the U.S. places them at significant and increasing risk as well. In turn, a growing body of work strongly associates high HIV prevalence in minority urban populations with the processes of coupled physical and social disintegration which have produced the now-common and politically-generated 'hollowed out' pattern of U.S. cities. We conclude that a return to the principles of the Great Reform Movement, which first brought public health and public order to U.S. urban areas, is a necessary, but at present largely unrecognized, component to any successful national program to control AIDS in the United States, and particularly to stem the diffusion of HIV into heterosexual populations outside present diseases epicenters.

Acquired Immunodeficiency Syndrome

Sterilization in Bangladesh: mortality, morbidity, and risk factors.

Although surgical sterilization in Bangladesh is common and has been designated as the primary means of helping the country slow its population growth, no reliable information exists regarding the procedure's safety. To define the types and rates of medical complications associated with sterilization, we followed 5042 women and 264 men undergoing sterilization. The problems that increased most markedly after the procedure compared with before included painful urination, shaking chills, fever for at least 2 days, and frequent urination. Most of the postoperative problems could be predicted by the presence of the same problem before the operation. Factor analysis of complaints in those persons who did not have a specific preoperative complaint showed that complaints clustered into three groups: urinary tract symptoms (urinary urgency and frequency), skin problems (bleeding from the incision, sore with pus, and stitches or skin breaking open), and general complaints (weakness and dizziness). The patient's sex, the sponsor and patient load of the sterilization center, and the dose of sedatives administered to women were significantly associated with specific postoperative complaints. Five women died during the study, resulting in a death-to-case rate of 9.9/10,000 procedures tubectomies; four deaths were due to respiratory arrest caused by oversedation.

Adult

Maternal and abortion related deaths in Bangladesh, 1978-1979.

The incidence and causes of pregnancy-related deaths are unknown for most of Asia; only local area studies have been done for Bangladesh. Between December 1978 and May 1979, we interviewed 118 health workers in 63 hospitals and 732 non-hospital facilities to identify case reports of maternal and abortion-related deaths in Bangladesh. Of 1933 pregnancy-related deaths identified, 498 (25.8%) were due to induced abortion. Abortion mortality rates varied significantly in the 18 administrative districts; the highest were in Dinajpur and Chittagong, the most northern and southern districts, and the lowest in Comilla and Noakhali. We used an earlier study of maternal mortality to estimate that about 21,600 pregnancy-related deaths occur each year in Bangladesh. We estimate that about 7.5% of all pregnancy-related deaths were identified in this survey. We infer from these data that safe and effective fertility control, including abortion performed by adequately trained health workers in both in- and out-patient facilities, might be the most appropriate first step in preventing pregnancy-related deaths in Bangladesh.

Abortion, Induced

The effect of enflurane and fentanyl anaesthesia on human platelet aggregation in vivo.

In 30 patients undergoing major operations, and anaesthetized with either nitrous oxide, oxygen and enflurane, or nitrous oxide, oxygen and fentanyl, there was no significant alteration in platelet aggregation induced by either adenosine diphosphate or collagen. The absence of any significant effect on platelet function was confirmed by an unchanging thromboelastogram pattern during the study.

Adenosine Diphosphate

Intraoperative physiologic monitoring and management during hepatic lobectomy using the liver isolation-perfusion technic.

The high operative mortality of major hepatic resection for tumor can be improved by a technic of resection using complete vascular isolation and hypothermic perfusion of the liver. Complete clamping of the portal vein, vena cava, and hepatic artery was necessary and well tolerated. Major physiologic, biochemical, and coagulation changes, however, can occur with this technic that requires close monitoring by the anesthesiologist. With astute observation and prompt corrective measures when indicated, these changes can be minimized to enable a safe and smooth resection to be carried out.

Acid-Base Equilibrium

Computerized decision support for concurrent utilization review using the HELP system.

OBJECTIVE: Development and evaluation of computerized concurrent utilization review (UR) support taking advantage of a clinically rich computerized patient database. DESIGN: The Automated Support System for Utilization Review (ASSURE) applies the Appropriateness Evaluation Protocol (AEP) Day of Care criteria to computerized patient data in the HELP hospital information system. This paper reports the development, verification, and validation of ASSURE. MEASUREMENTS: Implementation correctness was verified by measuring agreement with a nurse reviewer, using separate sample sets for all 20 criteria for a total of 560 current inpatients. Usefulness in detecting inappropriate days of care was validated by two nurse reviewers who were crossed with manual and computer-assisted review methods in a blocked design for 168 current inpatients. Agreement with reviewers, sensitivity, specificity, positive predictive value, and negative predictive value were measured. RESULTS: Agreement was very good for satisfaction of criteria, and good for appropriateness of day of care. A patient day identified by ASSURE as potentially inappropriate would be twice as likely to be judged inappropriate by a reviewer as a randomly selected patient day. Review of the 10% of patient days identified as potentially inappropriate by ASSURE would identify approximately 21% of the inappropriate days of care. CONCLUSION: ASSURE is a clinically useful tool for screening adult acute care patients for inappropriate days of care, and promises to make a major contribution to reducing health care costs. The prognosis for successful routine clinical use is good.

Artificial Intelligence

Fibrinogen and albumin deficiencies associated with packed red blood cell transfusions.

Fibrinogen content was determined for each of 50 units of citrate-dextrose-phosphate (CPD)-preserved whole blood, packed red blood cells reconstituted with 250 ml. of saline, and packed red cells reconstituted with 250 ml. of purified plasma protein fraction (PPF). The total protein and albumin were measured, by electrophoresis, on each of 10 units of the three varieties of blood. The fibrinogen content of the two types of reconstituted cells was significantly lower than that of whole blood. Although the total protein/albumin content of whole blood and PPF-reconstituted red cells was similar, saline-reconstituted cells were markedly deficient in both total protein and albumin. Low fibrinogen and platelet levels subsequent to transfusion with reconstituted packed red cells can lead to an erroneous diagnosis of disseminated intravascular coagulation. Administration of large quantities of saline-reconstituted packed cells could be an etiologic factor in postoperative interstitial pulmonary edema.

Adult