Spontaneous osteonecrosis of the capitate--a case report.
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Adult↗
Biomedical subjects
R Davis
Publications and source records attributed to R Davis.
The effects of immersiveness on physiology.
The effects of varying levels of immersion in virtual reality environments on participant's heart rate, respiration rate, peripheral skin temperature, and skin resistance levels were examined. Subjective reports of presence were also noted. Participants were presented with a virtual environment of an airplane flight both as seen from a two-dimensional computer screen and as seen from within a head-mounted display. Subjects were randomly assigned to different order of conditions presented, but all subjects received both conditions. Differences between the non-phobics' physiological responses and the phobic's response when placed in a virtual environment related to the phobia were noted. Also noted were changes in physiology based on degree of immersion.
Adult↗
p53 mutations in malignant gliomas.
A population-based series of incident cases of malignant glioma were analyzed for mutations in the tumor suppressor gene p53. Exons 4-8 were screened using PCR-single-strand conformation analysis and confirmed through direct sequencing. Of 62 tumors analyzed, 12 (19%) contained mutations in p53: one 18-bp duplication in exon 5, five point mutations in exon 4, three point mutations in exon 7, two point mutations in exon 8, and a splice-site mutation at the exon 6/intron 7 boundary. In contrast to previous studies of malignant glioma, the prevalence of transversion mutations (56%) was higher than transition mutations (33%). A large proportion of transversion mutations occurred in exon 4, a region that is not routinely screened in gliomas. We present here an improved method for screening exon 4 (and other GC-rich regions) of p53 using PCR-single-strand conformation analysis. The high frequency of transversion mutations suggests a role for exogenous carcinogens in the etiology of malignant glioma.
Adolescent↗
Physical fitness: how to help older patients live stronger and longer. (1).
Most older Americans are not physically fit and do not exercise regularly. This is especially true of older women, who are weaker than men and become disabled and dependent in the later years at a much greater rate. Exercise can increase the body's metabolism and make it more efficient in burning calories. Physical fitness also makes respiration more efficient. Evidence suggests strongly that the physically fit live 2 to 3 years longer and have a better quality of life than sedentary individuals. Any time is the best time for a person of any age to start exercising. Exercise is movement--dancing, walking, lifting a weight, using the body. Older individuals tend to be willing to exercise if they are given appropriate recommendations and follow-up.
Aged↗
A conversation with the NBC chairman: a way I thought I could contribute.
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Certification↗
Physical fitness: benefits of exercise for the older patient. 2.
Exercise provides important benefits for older adults in the areas of cardiovascular function, strength and muscle mass, postural stability, and psychological function. These benefits can be achieved by those who are healthy, as well as by the frail and very old. Physicians can use a simple screening test to identify patients at risk for loss of mobility and function due to muscle weakness. Exercise helps prevent hip fractures from falls by increasing bone density, coordination, balance, and muscle strength. It is also an important treatment for patients with arthritis, Parkinson's disease, stroke, and other chronic diseases of aging. Patients who exercise show improvements in depressive symptoms and sleep disorders.
Activities of Daily Living↗
Physical fitness: exercise prescription for older adults. 3.
Patients age 50 and older who are seen by primary care doctors are in various stages of wellness, ranging from healthy to frail. Because of this diversity, exercise prescription needs to be individualized, based on many of the same principles as drug prescription. Fitness programs typically include exercises to improve posture, aerobics, flexibility, strength, and balance. Exercising for 5 minutes a day is a good starting point, with sessions increasing gradually to 20 to 30 minutes. Trunk strengthening exercise can help patients stand from soft, low chairs. Ankle exercises can reduce the risk of falls and hip fractures. Weight training is safe and effective exercise for older patients.
Aged↗
Gender gap in cystic fibrosis mortality.
The authors conducted the largest study to date of survival in cystic fibrosis. The study cohort consisted of all patients with cystic fibrosis seen at Cystic Fibrosis Foundation-accredited care centers in the United States between 1988 and 1992 (n = 21,047), or approximately 85% of all US patients diagnosed with cystic fibrosis. Cox proportional hazards regression analysis was used to compare the age-specific mortality rates of males and females and to identify risk factors serving as potential explanatory variables for the gender-related difference in survival. Among the subjects 1-20 years of age, females were 60% more likely to die than males (relative risk = 1.6, 95% confidence interval 1.4-1.8). Outside this age range, male and female survival rates were not significantly different. The median survival for females was 25.3 years and for males was 28.4 years. Nutritional status, pulmonary function, and airway microbiology at a given age were strong predictors of mortality at subsequent ages. Nonetheless, differences between the genders in these parameters, as well as pancreatic insufficiency, age at diagnosis, mode of presentation, and race, could not account for the poorer survival among females. Even after adjustment for all these potential risk factors, females in the age range 1-20 years remained at greater risk for death (relative risk = 1.6, 95% confidence interval 1.2-2.1). The authors concluded that in 1- to 20-year-old individuals with cystic fibrosis, survival in females was poorer than in males. This "gender gap" was not explained by a wide variety of potential risk factors.
Adolescent↗
Familial and personal medical history of cancer and nervous system conditions among adults with glioma and controls.
The causes of glioma, the most common type of primary malignant brain tumor, are poorly understood. This study compared the personal and first-degree familial medical histories of 462 adults newly diagnosed with glioma in the San Francisco Bay Area between August 1, 1991, and March 31, 1994, with those of 443 controls who were frequency-matched on age, sex, and ethnicity. Cases and controls had equivalent personal histories of cancers other than brain cancer and most nervous system conditions, but they differed significantly regarding histories of epilepsy, seizures, or convulsions 3 or more years prior to diagnosis (odds ratio = 3.3, 95% confidence interval (CI) 1.4-7.9), chickenpox (odds ratio = 0.4, 95% CI 0.3-0.6), and shingles (odds ratio = 0.5, 95% CI 0.3-0.8). Four cases (less than 1%) and no controls had known genetic disorders (three had neurofibromatosis and one had tuberous sclerosis). Cases and controls had similar family histories of cancer and seizures. However, the odds ratio for a validated family history of primary brain tumor was 2.3 (95% CI 1.0-5.8). These results suggest that although family history of any cancer probably is not an important risk factor for adult glioma, a family history of brain tumors may play a role. Variation in exposure to or biologic response to common viral infections might play a greater role in the etiology of adult glioma than family history.
Adult↗
Cyclists should wear helmets.
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Accidents, Traffic↗
A metalloproteinase disintegrin that releases tumour-necrosis factor-alpha from cells.
Mammalian cells proteolytically release (shed) the extracellular domains of many cell-surface proteins. Modification of the cell surface in this way can alter the cell's responsiveness to its environment and release potent soluble regulatory factors. The release of soluble tumour-necrosis factor-alpha (TNF-alpha) from its membrane-bound precursor is one of the most intensively studied shedding events because this inflammatory cytokine is so physiologically important. The inhibition of TNF-alpha release (and many other shedding phenomena) by hydroxamic acid-based inhibitors indicates that one or more metalloproteinases is involved. We have now purified and cloned a metalloproteinase that specifically cleaves precursor TNF-alpha. Inactivation of the gene in mouse cells caused a marked decrease in soluble TNF-alpha production. This enzyme (called the TNF-alpha-converting enzyme, or TACE) is a new member of the family of mammalian adamalysins (or ADAMs), for which no physiological catalytic function has previously been identified. Our results should facilitate the development of therapeutically useful inhibitors of TNF-alpha release, and they indicate that an important function of adamalysins may be to shed cell-surface proteins.
ADAM Proteins↗
Evidence for a role of Rho-like GTPases and stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK) in transforming growth factor beta-mediated signaling.
Transforming growth factor beta (TGF-beta) is a multifunctional factor that induces a wide variety of cellular processes which affect growth and differentiation. TGF-beta exerts its effects through a heteromeric complex between two transmembrane serine/threonine kinase receptors, the type I and type II receptors. However, the intracellular signaling pathways through which TGF-beta receptors act to generate cellular responses remain largely undefined. Here, we report that TGF-beta initiates a signaling cascade leading to stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK) activation. Expression of dominant-interfering forms of various components of the SAPK/JNK signaling pathways including Rho-like GTPases, mitogen-activated protein kinase (MAPK) kinase kinase 1 (MEKK1), MAPK kinase 4 (MKK4), SAPK/JNK, and c-Jun abolishes TGF-beta-mediated signaling. Therefore, the SAPK/JNK activation contributes to TGF-beta signaling.
Calcium-Calmodulin-Dependent Protein Kinases↗
Long-term survival of elderly trauma patients.
OBJECTIVE: To evaluate the long-term survival and factors that influence survival among a cohort of elderly trauma patients compared with an uninjured cohort. DESIGN: A retrospective cohort analysis. DATA SOURCES: Health Care Finance Administration, Baltimore, Md, Medicare data. SUBJECTS: A cohort of elderly patients (n = 9424) hospitalized for injury in 1987 was identified using Medicare hospital discharge abstract data. An uninjured comparison group (n = 37,787) was identified from Medicare eligibility files. For injured patients, an Injury Severity Score was generated from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9CM) codes. For both cohorts, preexisting illness was assessed by ICD-9CM codes from Health Care Finance Administration outpatient and inpatient data files for 1986 and 1987. MAIN OUTCOME MEASURES: Relative risk for mortality within 5 years subsequent to injury, adjusted for age, sex, and preexisting illness, using Cox proportional hazard regression. RESULTS: The injured cohort had a significantly reduced 5-year survival when compared with the uninjured group (relative risk [RR] = 1.71; 95% confidence interval, 1.66-1.77). The lower survival persisted even among patients who survived at least 3 years after injury. Coexisting disease, age, and Injury Severity Score were strong predictors of survival. CONCLUSIONS: The adverse effect of trauma on survival in elderly patients is not isolated to the immediate postinjury period, but lasts years after the trauma episode. Further study is required to identify the reasons for this persistent effect of trauma on subsequent survival.
Aged↗
Group psychoeducation for bulimia nervosa with and without additional psychotherapy process sessions.
OBJECTIVE: The present study examined whether additional sessions of group psychotherapy process (PP) would incrementally benefit bulimia nervosa (BN) subjects over and above that which is achieved through a course of brief group psychoeducation (PE). METHOD: Utilizing a quasi-experimental design, the first cohort of 40 BN subjects completed five-session PE-alone groups that were highly didactic and explicitly devoid of group process work. The second cohort of 41 BN subjects completed 12-session PE + PP groups that integrated PE with more conventional cognitive-behavioral group process interventions. RESULTS: Both treatments were associated with comparable levels of change on measures of specific and nonspecific psychopathology. Furthermore, the two treatments did not differ in rates of premature termination, in rates of remission in eating symptoms, in rates of normalization of scores on psychometric measures, or in consumer evaluation of the treatments. DISCUSSION: While subjects value the opportunity to engage in psychotherapy process with other group members, the addition of seven such sessions offers no enhanced therapeutic benefit over five sessions of group PE.
Adolescent↗
A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa: short-term outcome.
This study compared and combined fluoxetine and individual cognitive behavioral therapy in the treatment of bulimia nervosa. Participants were 76 women who sought treatment at the Eating Disorders Program of the Toronto Hospital and who met DSM-III-R criteria for bulimia nervosa. Subjects were randomly assigned to receive fluoxetine alone, cognitive behavior therapy alone, or the two in combination and were treated over 16 weeks. Short-term outcome revealed that all three treatment conditions were associated with clinical improvement across a wide range of parameters. The combination of pharmacotherapy and psychotherapy was superior to pharmacotherapy alone on specific parameters and there was no statistically significant advantage to the combination over psychotherapy alone. Limitations to the study include the absence of a placebo pill group and a waiting list control group as well as a substantial dropout rate across all three treatment conditions.
Adolescent↗
Risk of hospitalization because of aseptic meningitis after measles-mumps-rubella vaccination in one- to two-year-old children: an analysis of the Vaccine Safety Datalink (VSD) Project.
OBJECTIVE: To assess the level of increased risk, if any, of hospitalizations for aseptic meningitis after Jeryl-Lynn mumps strain measles-mumps-rubella (MMR) vaccine in the Vaccine Safety Datalink population. STUDY DESIGN: A possible increased risk of aseptic meningitis 8 to 14 days after receipt of MMR was observed in a preliminary screening analysis of automated data from the Vaccine Safety Datalink (VSD) project Year 2 analysis. To further evaluate this association a retrospective 10-year matched case-control study was undertaken in the four health maintenance organizations (HMOs) in the VSD project. Cases ascertained from a broad scan of the automated data were validated against a standard case definition. Two controls matched on age, sex, HMO and HMO membership were assigned per case. RESULTS: The VSD project involves the cooperative collection of automated vaccination and medical outcome data from four large HMOs that currently have 500,000 children younger than 7 years of age under surveillance. Review of automated screening results from the first 2 years of data revealed a possible increased risk of aseptic meningitis 0 to 14 days after MMR with a relative risk of 3.61 (95% confidence interval, 1.0 to 13.1) although the total number of cases was small. Although the automated data had suggested a possible association of aseptic meningitis with MMR containing the Jeryl-Lynn strain of mumps, review of validated hospitalized cases during the observation period did not reveal evidence of an increased risk of aseptic meningitis after MMR containing the Jeryl-Lynn strain of mumps (odds ratio < 1.0 for all analyses). CONCLUSION: Although it is recognized that hospitalized cases represent a minority of the total cases of aseptic meningitis, it is reassuring that in this evaluation no increased risk of aseptic meningitis after MMR vaccine was found.
Case-Control Studies↗
Community caring: an ethnographic study within an organizational culture.
American society is demanding that health care organizations design a health care system that is more responsive to the needs of their communities. In their efforts to respond, organizations are challenged to better understand organizational dynamics, community needs, and community relationships. The purpose of this study was to explore and understand the meaning of caring for the community from the perspective of care providers in a hospital-based ambulatory program. Using a focused ethnographic design, the study was conducted in a community hospital close to a large metropolitan city. Research methods included open-ended interviews, participant observations, and examination of documents. Analysis of data revealed five major themes related to the experience of caring for the community. Themes reflected different perspectives of communities, reciprocal relationships and teams, education and prevention, shared values, and understanding community needs. At the same time, an overarching theme related to wellness, growth, and empowerment emerged. Results provided knowledge that may help increase understanding of organizational culture that impacts the development of healthy communities. Findings may also help facilitate organizational change toward the development of new models of care that are integrated with the community.
Anthropology, Cultural↗