The underinsured: how much do we care?
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Biomedical subjects
Publications and source records attributed to S Parker.
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The plasma glucose and serum insulin responses were determined in untreated Type 2 (non-insulin-dependent) diabetic patients following the ingestion of foods containing sucrose, glucose, fructose or lactose in portions that contained 50 g of carbohydrate. The results were compared to those obtained following the ingestion of pure fructose, sucrose, glucose + fructose and lactose. The objectives were to determine 1) if the glucose response to naturally occurring foods could be explained by the known carbohydrate content, and 2) whether the insulin response could be explained by the glucose response. The glucose response was essentially the same whether the carbohydrate was given as a pure substance, or in the form of a naturally occurring food. The glucose response to each type of carbohydrate was that expected from the known metabolism of the constituent monosaccharides. The glucose areas following the ingestion of the foods were: Study 1: glucose 11.7, orange juice 7.3, sucrose 5.2, glucose + fructose 6.3, and fructose 0.7 mmol X h/l; Study 2: glucose 14.6, orange juice 7.3, apples 5.5, and apple juice 4.7 mmol X h/l; Study 3: glucose 12.6, ice cream 8.1, milk 3.7, and lactose 4.1 mmol X h/l. The insulin response was greater than could be explained by the glucose response for all meals except apples. Milk was a particularly potent insulin secretagogue; the observed insulin response was approximately 5-fold greater than would be anticipated from the glucose response. In summary, the plasma glucose response to ingestion of fruits and milk products can be predicted from the constituent carbohydrate present. The serum insulin response cannot.
Each of 7 subjects matched the loudness of a single tone to the loudness differences within tone pairs (Experiment 1), gave magnitude estimations of those differences (Experiment 2), and gave magnitude estimations of single tonal loudness (Experiment 3). Individual subjects used several loudness scales to perform these tasks, in accordance with Marks's (1979b) theory. At least 3 subjects used the same scale to match loudnesses to loudness differences and to give magnitude estimations of the loudness of single tones (Experiments 1 and 3), but used a shallower sloped scale when giving magnitude estimations of loudness differences (Experiment 2).
A sigmoidovesicular fistula developed in a hemophiliac from a spontaneous sigmoid intramural hematoma. As the hemophiliac population lives longer as a result of improved factor therapy, they will develop more of the diseases and complications of age.
Hypertension after cardiac surgery is common and requires accurate control by carefully regulated infusions of drugs such as sodium nitroprusside. A microprocessor-based controller has been designed to close the loop between the blood pressure response and the infusion rate of a hypotensive drug. This system has been refined by computer simulation of the blood pressure response to sodium nitroprusside and by experience gained in using the controller in eleven patients in the early recovery period after cardiac surgery. The controller was able automatically to maintain blood pressure within 10% of a specified value. Provision of sophisticated safety features in automatic drug infusion controllers is essential for patient protection.
To assess the validity of self-reported marijuana use during pregnancy, this study randomly allocated pregnant women into a group who were told their urine would be tested for marijuana, alcohol, and other drugs and another group not so tested. Women told they would be tested reported more marijuana use during pregnancy than did untested women. Moreover, urine assays identified more women who used marijuana during pregnancy than were willing to admit it in the interview even after being told their urine would be tested. No differences in reported drinking or cigarette smoking during pregnancy were found between tested and untested women.
Thirty-four patients with a clinical diagnosis of plaque stage mycosis fungoides, poikiloderma atrophicans vasculare (poikiloderma) and parapsoriasis en plaques (parapsoriasis) were investigated for evidence of extracutaneous disease using a biochemical screen, blood films, bone marrow examination, chest radiograph, abdominal ultrasound, isotope liver scan, liver biopsy and lymphangiography. Skin biopsies were also taken from these patients and, in order to rule out non-specific histological change, from 29 controls with inflammatory skin disease; the slides were examined blind by two independent observers for evidence of mycosis fungoides or poikiloderma and graded accordingly. Both observers were able to differentiate significantly histological grades of mycosis fungoides corresponding to the clinical diagnosis although exact histological grades only corresponded on 35 per cent of slides. Features graded as classical or probable mycosis fungoides were found in between 22 and 67 per cent of patients with parapsoriasis and between 67 and 100 per cent of those with poikiloderma. We found no evidence of extracutaneous disease in any of our patients. Lymphangiograms were abnormal in 30 of 31 examinations but the changes were non-specific and did not correspond to disease type, duration or extent. Four patients had apparently unrelated co-existing disease including chronic lymphatic leukaemia in two, a monoclonal gammopathy and autoimmune haemolytic anaemia. This study shows that in its early stages mycosis fungoides is predominantly if not primarily a cutaneous disease. The findings also suggest that parapsoriasis and poikiloderma are part of the same disorder as mycosis fungoides or evolve into it. Aggressive treatment to prevent progression to mycosis fungoides plaque and tumour stage should therefore be tried. The findings support the idea that mycosis fungoides is a reactive rather than a neoplastic disorder.
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There is much evidence that endogenous opioid peptides are involved in the regulation of food and water intake in a variety of species. We report here that the exogenous opiate agonist, butorphanol tartrate (1 microgram/kg), significantly increases food, but not water, intake in normal humans. The major effect on food intake was seen within the first 2 h after the administration of drug. These findings suggest that this drug may be therapeutically useful in patients with cancer anorexia.
Forty one patients whose psoriasis cleared with dithranol were given prophylatic photochemotherapy with psoralens and ultraviolet A once a week. With life table analysis the chance of remaining in remission for 16 months was shown to be 42% for these patients, compared with 13% for a group of patients who were not given prophylactic photochemotherapy.
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Twenty-eight patients with chronic plaque psoriasis affecting 20-40% of their body surface were treated with either PUVA and placebo (thirteen patients) or PUVA and etretinate (0.75 mg/kg) (fifteen patients). PUVA was given three times a week for a maximum of 10 weeks after a 2-week period on placebo or etretinate alone. Four patients failed to clear with PUVA and placebo compared with one patient with PUVA and etretinate, and the mean total UV-A dose to clear was lower with etretinate (mean = 62.1 J/cm2) than with placebo (mean = 77.3 J/cm2) but none of these differences were significant. Because the additional response to etretinate was only marginal, whilst unwanted effects were common, we found no advantage in adding etretinate to PUVA.
Seventeen patients with palmoplantar pustular psoriasis and three with hyperkeratotic psoriasis of palms and soles were treated with either PUVA-etretinate (1 mg/kg) or PUVA-placebo. Patients were randomly allocated to each group and the trial was conducted according to a double-blind protocol, so far as the side-effects of etretinate made this possible. PUVA was given three times a week for a maximum of 18 weeks, after 2 weeks on daily placebo or etretinate alone. All ten patients in the PUVA-etretinate group cleared, but there were four failures in the PUVA-placebo group (P = 0.03). The PUVA-etretinate treated patients required significantly fewer PUVA treatments (13.1 +/- 2.9; mean +/- s.e.) and cleared in a significantly shorter time (30.3 +/- 7.1 days) than the PUVA-placebo group (23.2 +/- 4.2 treatments; 59.2 +/- 11.5 days, P less than 0.05). The cumulative UV-A dose to clear was less in the PUVA-etretinate group (53.9 +/- 18.5 J/cm2) than the PUVA-placebo group (113.1 +/- 33.4 J/cm2). This difference was not significant due to the exceptionally large dose of UV-A used on one patient but the results were significant when it was excluded. The therapeutic advantage of adding etretinate to PUVA is offset by the side-effects of cheilitis, hair loss and peeling skin which occurred in eight of the ten PUVA-etretinate patients, and an increase in fasting triglyceride concentrations and serum alkaline phosphatase activity.
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Cimetidine, ranitidine, or water was administered to pregnant rats from the 12th day of pregnancy through weaning at 21 days of age. The effects of such treatments upon the male progeny were evaluated. Anogenital distance and indices, measures of masculinity, were found to be reduced (p less than 0.05) in pups of cimetidine-exposed dams but not in the pups obtained from either the ranitidine or water controls. In addition, at 55 days and 110 days of age, the testes and ventral prostate-seminal vesicles (androgen-responsive tissues) of the rats exposed to cimetidine were smaller (p less than 0.05) than those of the other two groups. Moreover, at both 55 and 110 days of age, the testosterone levels were reduced (p less than 0.05) in these same pups. Despite the fact that the cimetidine-exposed animals had reduced testosterone levels compared with the levels of the other two groups, the luteinizing hormone levels did not differ among the three groups. Finally, both before and after exogenous androgen replacement, the sexual behavior of the cimetidine-exposed animals was diminished when compared with that of the other two groups.
Methylated oligo- and polysaccharides can be rapidly and efficiently separated from the reaction mixtures used to methylate them using a Waters C18 Sep-Pak cartridge. The methylated saccharides are retained by the Sep-Pak as the reaction mixture, diluted fivefold with water, is passed through. Extraneous materials are washed away with water, and then the sugars are eluted with 50 or 100% methanol. Samples of up to approximately 4 mg can be accommodated. Extremely small samples (10-50 micrograms) can also be purified.
Aerosol control is a significant problem in agriculture and industry. Two separate studies were conducted to determine the effectiveness of a "negative air ionization" system in aerosol control. The first study was conducted with a turkey "brooder" barn and a control for a six-week period. The second study was conducted with a turkey "grow-out" barn and a control for a twelve-week period. Sampling parameters for both studies included environmental aerosol sampling, ion imbalance measurements, relative humidity, temperature and barometric pressure measurements and daily turkey mortality. Study two also included post study bird weights. Results of sampling parameters were consistent between study one and study two. No significant difference was found between test and control total average aerosol concentration for both studies. Ion imbalance measurements served to indicate that test environments were negatively ionized while control environments experienced normal environmental conditions. Meteorological parameters did not significantly affect aerosol concentrations. Normal variations in bird mortality were observed in the first study, but death rates increased with ionization in the latter. Overall, it was determined that the "negative air ionization" could not be considered as an effective means of aerosol control in turkey rearing confinements.