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Biomedical subjects

S Miller

Publications and source records attributed to S Miller.

At least 451 records · Page 25Linked to original sources
PubMed1987

The impact of cost containment on alcohol and drug treatment.

Hospitals offering alcohol and drug treatment programs that meet certain criteria are currently exempt from Medicare's prospective payment system, which was introduced in October 1983 as a means of containing medical costs. Substance abuse experts have successfully lobbied for changes in the alcohol and drug diagnosis-related groups (DRGs) on which reimbursement is based so that they now more accurately reflect patterns of inpatient detoxification and rehabilitation. However, major adjustments are still necessary to protect the quality of care and financial diversity of substance abuse treatment programs. Differences in types of treatment facilities must be considered in order to prevent a major redistribution of funds away from facilities offering specialized care. Incentives to reduce costs must be balanced with a determination to maintain high-quality care.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1987

A state mental health system with no state hospital: the Vermont Feasibility Study.

A comprehensive study of both the feasibility and the desirability of operating a state mental health system without a state hospital, except for a small forensic facility, was carried out in Vermont. Feasibility was examined in terms of client needs, service system capabilities, financing, human resource requirements, legal and rights protection issues, and political considerations. The study team concluded that developing comprehensive regional community support and rehabilitation services to replace the state hospital for all public mental health clients except forensic patients was both feasible and desirable since it would result in better services at a roughly equivalent cost to the state. The team also developed recommendations for optimizing the success of regionalization.

Community Mental Health Services↗
PubMed1987

Shortcomings of physical examination and impedance plethysmography in the diagnosis of lower extremity deep venous thrombosis.

Accuracy in the diagnosis of lower extremity deep venous thrombosis (DVT) by physical examination and impedance plethysmography (IPG) is reviewed. Physical examination proved unreliable in distinguishing patients with and without acute disease. Swelling in the leg was, however, more prevalent in patients with DVT. The sensitivity and specificity of IPG were less than those reported by other groups. Venography remains the most reliable diagnostic procedure in our institution.

Humans↗
PubMed1987

Transient neutropenia of childhood.

Patient characteristics and clinical course are described in 21 children with newly discovered neutropenia (absolute neutrophil count less than 1500/microliter). Only children over age 3 months are included; 19 of 21 were less than age 2 years. The majority had respiratory tract infections and 11 had been on various medications at the time neutropenia was discovered. Bacteria were isolated from the blood of three patients (S. pneumoniae in two, H. influenzae in one) and from urine in one (E. coli). Respiratory syncytial virus was cultured from the nasopharynx of two patients. Opportunistic, gram-negative and staphylococcal infections did not occur. Neutrophil counts in all but one child returned to normal within 6 weeks of onset; half recovered within 7 days. Bone marrow examination was performed in 13 patients: maturation arrest at various stages in the myeloid series was noted in six, and seven had normal myeloid maturation. Bone marrow findings did not correlate with degree or duration of neutropenia. These observations indicate that previously well infants with isolated neutropenia generally have a benign clinical course, although three patients were ultimately proven to have significant chronic illness. Recommendations are made as to management.

Agranulocytosis↗
PubMed1987

Adapting personal computers for use by high-level quadriplegics.

A communication instrument has been developed for use by a quadriplegic person who is limited solely to eye motion as a control input. The instrument uses an infrared-emitting diode/phototransistor sensor mounted on the frame of a pair of eyeglasses to transform deliberate lateral eye motion into a contact-closure output form. A software program has also been developed for use with this instrument to display letters of the alphabet in a series of six lines. The lines are slowly scrolled until the desired line is reached, then stopped by a lateral eye motion. The scrolling then continues for each character in that line until the desired character is reached. Again, lateral eye movement causes the scrolling to stop and the character becomes part of a string. This process continues until a command character is selected whereby the string can be sent to a printer, spoken through a speech synthesizer, or erased.

Adult↗
PubMed1986

Equine protozoal myeloencephalitis in a pony.

A 10-year-old pony died 5 days after the onset of a nervous disorder. Necropsy revealed a yellowish area of discoloration (1.5 by 1 cm) in the medulla oblongata. Microscopically, necrosis and nonsuppurative myeloencephalitis were found in the medulla oblongata. Immature and mature meronts (25 by 10 microns) were seen in neural tissue and in capillaries of the brain stem. Organisms were similar structurally to those seen in equine protozoal myeloencephalitis of horses.

Animals↗
PubMed1986

Visual field defects in cats with neonatal or adult immunological loss of retinal ganglion cells.

Behavioral perimetry methods were used to assess the monocular visual fields of 12 cats that had received intraocular injections of antibodies against large (alpha/Y) retinal ganglion cells. The antibodies produced defects in head and eye orientation responses to stimuli presented in the nasal visual field of the treated eye; responses to stimuli in the temporal visual hemifield were normal. Similar results were seen in cats that received antibody injections at 4 weeks of age or as adults. In the context of previous results, these findings suggest that a loss of Y cells in the lateral geniculate nucleus is sufficient to reduce geniculocortical function for head and eye orientation to visual stimuli in the nasal visual field.

Animals↗
PubMed1986

Epizootiologic investigations on a sheep farm with Toxoplasma gondii-induced abortions.

During the lambing season of 1983/1984, 8 of 44 purebred Hampshire ewes on a farm in Knoxville, Md had reproductive problems. In at least 4 of these ewes, the problem was attributed to toxoplasmosis. Necrosis and Toxoplasma gondii tachyzoites were found in placental specimens from 3 ewes. Agglutinating antibody to T gondii, at a titer of 1:80, was found in pleural fluids of both fetuses aborted from 1 ewe; this ewe had an antibody titer of 1:6,400 at the time of abortion. In another ewe, the diagnosis was confirmed by the isolation of T gondii from the placenta and 1 of her lambs. Of numerous free-roaming adult cats on the farm, 16 were trapped, euthanatized, and examined for T gondii. Agglutination antibody to T gondii, at titers of 1:4 to 1:64, was found in serum samples from all the cats. Toxoplasma gondii was isolated from the brain and skeletal muscles of 9 of the cats, and from the feces of 1 cat. Blood samples obtained from all 78 sheep on the farm 6 months after the episode of abortion were examined for antibody to T gondii. Agglutinating antibody titers to T gondii were less than 1:16 in 46 sheep, 1:16 in 16, 1:64 in 12, 1:256 in 2, 1:024 in 1, and 1:4,096 in 1. Analyses of serologic data in sheep of various age groups suggested that the Toxoplasma infection was acquired sporadically, probably from feed contaminated with oocysts.

Abortion, Veterinary↗
PubMed1986

Toxoplasma gondii-induced abortion in dairy goats.

Three of 8 goats on a Maryland farm aborted or had dystocia associated with toxoplasmosis during the winter of 1984. Doe 1 aborted a decomposed fetus 30 days before term. Modified agglutination test (MAT) antibody titers against Toxoplasma gondii were found in pleural fluid of the fetus (1:1,024) and in serum of doe (1:4,096 at 31 days after abortion). Doe 2 aborted a fetus 5 days before term; MAT antibody was found in the pleural fluid of the fetus (1:16,384) and in the doe's serum (1:4,096 on the day of abortion). Placenta from both does had foci of necrosis characteristic of toxoplasmosis, and T gondii was identified in lesions. Doe 3 had dystocia 7 days before term and a partially decomposed fetus was delivered by cesarian section; MAT was found in pleural fluid of the fetus (1:1,024) and in serum from the doe (1:4,096 on the day of abortion). Focal gliosis and calcification were seen in brain specimens from 2 of the 3 fetuses. None of the does produced milk after abortion. Two other does (No. 4 and 5) delivered apparently healthy kids transplacentally infected with T gondii; MAT in serum of both does was 1:4,096. Doe 4 delivered 3 kids; MAT titer in a serum from each kid 38 days after birth was 1:16,384. Doe 5 delivered 1 kid with a serum MAT titer of 1:1,024 at 38 days after birth. The 3 remaining does had MAT titers of 1:256, 1:16, and 1:16, and all delivered healthy kids. Epizootiologic evidence suggested that the does acquired T gondii infection from oocysts passed in feces of domestic cats on the farm. The MAT titers of 4 cats on the farm were 1:65,356; 1:1,024; 1:16; and 1:1,024.

Abortion, Veterinary↗
PubMed1986

Use of ultrasound to locate a "lost" tissue expander injection port.

We have presented a rapid and reliable method of finding lost injection valves. (A frustrating footnote, however, is that 1 week later the port had again migrated and could not be located. Since the further anticipated gain was marginal, the bladder was already nearly expanded, and the expense for repeated ultrasound was a consideration, no further attempts were made to locate this port by ultrasound for further filling).

Aged↗
PubMed1986

Reflex influences on muscle spindle activity in relaxed human leg muscles.

The study was designed to determine whether low-threshold cutaneous and muscle afferents from the foot reflexly activate gamma-motoneurons innervating relaxed muscles of the leg. In 15 experiments multiunit recordings were made from 21 nerve fascicles innervating triceps surae or tibialis anterior. In a further nine experiments the activity of 19 identified single muscle spindle afferents was recorded, 13 from triceps surae, 5 from tibialis anterior, and 1 from extensor digitorum longus. Trains of electrical stimuli (5 stimuli, 300 Hz) were delivered to the sural nerve at the ankle (intensity, twice sensory threshold) and the posterior tibial nerve at the ankle (intensity, 1.1 times motor threshold for the small muscles of the foot). In addition, a tap on the appropriate tendon at varying times after the stimuli was used to assess the dynamic responsiveness of the afferents under study. The conditioning electrical stimuli did not change the discharge of single spindle afferents. Recordings of rectified and averaged multiunit activity also revealed no change in the overall level of background neural activity following the electrical stimuli. The afferent responses to tendon taps did not differ significantly whether or not they were preceded by stimulation of the sural or posterior tibial nerves. These results suggest that low-threshold afferents from the foot do not produce significant activation of fusimotor neurons in relaxed leg muscles, at least as judged by their ability to alter the discharge of muscle spindle afferents. As there may be no effective background activity in fusimotor neurons innervating relaxed human muscles, it is possible that these inputs from the foot could influence the fusimotor system during voluntary contractions when the fusimotor neurons have been brought to firing threshold. In one subject trains of stimuli were delivered to the posterior tibial nerve at painful levels (30 times motor threshold). They produced an acceleration of the discharge of a spindle in soleus at a latency of approximately 125 ms, in advance of detectable activity in skeletomotor neurons and before an increase in muscle length was noted. It presumably resulted from activation of gamma-motoneurons innervating soleus by small myelinated afferents (A-delta range).

Electric Stimulation↗
PubMed1986

A crossed polaroid-pinhole device.

The study describes the use of a pinhole device in which the light-absorbing area surrounding the holes is varied by polarizing filters. The study demonstrates that a pinhole aperture of 1.6-1.8 mm in diameter with polaroids crossed at 90 degrees will allow a visual acuity equal to or better than 20/40 in the face of refractive errors of 1, 2, and 3 diopters. The study next evaluates the effects of pinholes of different sizes and the polarizing components crossed at angles less than 90 degrees. The study concludes by showing that polaroids crossed at between 75 degrees and 85 degrees allow a greater depth of focus, a larger visual field, and greater illumination than traditional pinhole devices.

Humans↗